Barriers and facilitators to learning health systems in primary care: a framework analysis.

BACKGROUND: The learning health system (LHS) concept is a potential solution to the challenges currently faced by primary care. There are few descriptions of the barriers and facilitators to achieving an LHS in general practice, and even fewer that are underpinned by implementation science. This study aimed to describe the barriers and facilitators to achieving an LHS in primary care and provide practical recommendations for general practices on their journey towards an LHS. METHODS: This study is a secondary data analysis from a qualitative investigation of an LHS in a university-based general practice in Sydney, Australia. A framework analysis was conducted using transcripts from semistructured interviews with clinic staff. Data were coded according to the theoretical domains framework, and then to an LHS framework. RESULTS: 91% (n=32) of practice staff were interviewed, comprising general practitioners (n=15), practice nurses (n=3), administrative staff (n=13) and a psychologist. Participants reported that the practice alignment with LHS principles was influenced by many behavioural determinants, some of which were applicable to healthcare in general, for example, some staff lacked knowledge about practice policies and skills in using software. However, many were specific to the general practice environment, for example, the environmental context of general practice meant that administrative staff were an integral part of the LHS, particularly in facilitating partnerships with patients. CONCLUSIONS: The LHS journey in general practice is influenced by several factors. Mapping the LHS domains in relation to the theoretical domains framework can be used to generate a roadmap to hasten the journey towards LHS in primary care settings.

Factors influencing early presentation to general practitioners for non-screen detected breast cancer.

BACKGROUND AND OBJECTIVES: Women living in rural Australia have worse survival rates for breast cancer compared with their urban counterparts. Identifying factors that contribute to delayed presentation could help to reduce this disparity. This study aimed to identify and explore the differences in help-seeking behaviours between rural and urban women with non-screen-detected breast cancer. METHOD: We conducted a qualitative study consisting of semi-structured interviews with 20 women from New South Wales with non-screen detected breast cancer that was diagnosed within the past five years. RESULTS: There was little difference between rural and urban groups in terms of symptom appraisal and monitoring, social interactions, and personal and environmental factors. However, the presence of stoicism as a barrier was unique to rural women. Rural women also faced significant barriers in accessing general practice services that pertained to availability, cost and distance. DISCUSSION: GPs play a critical role in facilitating earlier presentation, and more research into rural stoicism is required. Continued investment in the rural primary care workforce will be key to improving access issues.