When the phone rings - factors influencing its impact on the experience of patients and healthcare workers during primary care consultation: a qualitative study.

BACKGROUND: In the primary health care setting, patients interact directly with their healthcare workers (HCW), which include their primary physicians, nurses and pharmacists. Studies have shown that such interactions, when interrupted by phone calls received by either party, can lead to adverse outcomes and negative experiences. There is insufficient data however on the factors affecting the reaction and responses of both patients and HCWs when phone calls occur amidst their interaction. Understanding these factors will allow for the introduction of targeted measures to mitigate the negative impact of such interruptions and improve patient-HCW relationships. This study therefore aims to understand the impact of unplanned phone calls during primary health care consultations on patient-HCW interactions and the factors affecting the patient and the HCW responses. METHOD: This study used focus group discussions (FGD) to gather qualitative data from patients and HCWs who had visited or worked in a major public primary healthcare institution in Singapore. The FGDs were audio-recorded, transcribed, audited and analyzed using standard content analysis to identify emergent themes. RESULTS: 15 patients and 16 HCWs participated in 5 FGDs. The key themes that emerged from these FGDs were patients' and HCWs' attitudes toward professionalism and respect, task and thought interruption, call characteristics, the impact on patient safety and stakeholders' experiences. Phone calls during consultations answered by either party often resulted in the answering party feeling apologetic and would usually keep the phone conversations short as a sign of respect to the other party. Both stakeholders valued the consultation time and similarly reported negative experiences if the phone-call interruptions became prolonged. Calls from the desk phone answered by HCWs were perceived by most patients to be relevant to healthcare services, with the assumption that HCWs exercised professionalism and would not attend to personal calls during their clinical duties.HCWs expressed their concerns and distress about potential medical errors due to phone-calls interrupting their clinical tasks and thinking processes. However, they acknowledged that these same phone-calls were important to allow clarifications of instructions and improved the safety of other patients. CONCLUSION: Phone interruptions affected patient and HCW interaction during consultations and factors leading to their adverse reactions need to be recognized and addressed.

Aetiology of community-acquired urinary tract infection and antimicrobial susceptibility patterns of uropathogens isolated.

INTRODUCTION: Antibiotic resistance among uropathogens causing urinary tract infection (UTI) is increasing worldwide. In most cases of UTI, family physicians can provide empirical treatment without the benefit of a pre-therapy urine culture. Knowledge of the aetiology and antimicrobial susceptibility patterns of uropathogens is important in order to determine the best empiric treatment option. This study aimed to determine the aetiology and antimicrobial susceptibility of uropathogens in culture-positive, community-acquired UTIs over a one-year period. METHODS: This is a retrospective analysis of medical case records. All patients who were diagnosed and coded with UTI and had urine culture done were analysed. The prevalence of the UTI-causing organism and its antibiotic susceptibility was tabulated. Results were analysed with descriptive statistics. The chi-square and Fisher's exact tests were applied for categorical variables. RESULTS: The commonest organism isolated for all age groups and gender was Escherichia coli (74.5 percent) and Klebsiella spp. (8.7 percent). Among the oral antibiotics widely used in primary care in Singapore, the Enterobacteriaceae family was most susceptible to amoxicillin/clavulanate. There was no significant difference in the susceptibility of common oral antibiotics when tested against the Enterobacteriaceae for both male and female patients and between patients older than 65 years and those 65 years and below. CONCLUSION: Empirical treatment of community-acquired UTI with cotrimoxazole, ciprofloxacin, cephalothin and ampicillin is inadequate. Amoxicillin/clavulanate should be the drug of choice for empirical treatment instead.