How has the COVID-19 pandemic influenced patient-centred care? Analysis of a qualitative collective case study by high performing practice teams.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has significantly affected primary healthcare systems throughout the world. The aim of this article is to present the analysis of the perspectives and experiences of patient-centred care (PCC) during the pandemic by high-functioning general practice teams in Australia. METHOD: A qualitative descriptive approach and collective case study method was employed. Participants, who undertook a semi-structured interview, were representatives of high-functioning general practice teams. Reflective thematic analysis was applied to all interview data (meta-synthesis) using a constant comparison approach. RESULTS: Five clinic representatives were interviewed. Six themes developed, highlighting that despite the pandemic creating new challenges to delivering PCC, general practice teams maintained a focus on PCC. General practice teams adapted to deliver PCC through strategies not used prior to the pandemic. DISCUSSION: This study identified new approaches to PCC that can guide other general practices and progress the health system towards policy-based PCC objectives.

Patient-centred care during the COVID-19 pandemic: Protocol for a qualitative collective case study by high­performing general practice teams.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has changed the way general practice teams interact with patients. This protocol article describes the rationale and design of an exploration of the experiences and perceptions of patient-centred care (PCC) by high-functioning general practice teams in Australia. METHOD: A qualitative descriptive approach and collective case study method will be used. Potential participants are individuals representing a high-functioning general practice team, who will be asked to participate in a semi-structured interview. Eligible general practice clinics have received a 'Practice of the Year' award or commendation from The Royal Australian College of General Practitioners or Australian General Practice Accreditation Limited. Interview data will be analysed thematically, with constant comparison and meta-synthesis. DISCUSSION: Collective case study research is valuable because it enables rich exploration of PCC within the context of the pandemic. Rapid research on PCC may highlight new approaches towards the delivery of PCC.

Patient-centred care delivered by general practitioners: a qualitative investigation of the experiences and perceptions of patients and providers.

BACKGROUND: Patient-centred care (PCC) is care that is respectful and responsive to the wishes of patients. The body of literature on PCC delivered by general practitioners (GPs) has increased steadily over time. There is an opportunity to advance the work on GP-delivered PCC through qualitative research involving both patients and providers. AIM: To explore the perceptions and experiences of PCC by patient advocates and GPs. DESIGN AND SETTING: Qualitative description in a social constructivist paradigm. Participants were sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. METHOD: Purposive sampling was used to recruit English-speaking adult participants who were either practising GPs or patient advocates. Focus group sessions explored participants' perceptions and experiences of PCC. Data were analysed thematically using a constant-comparative approach. RESULTS: Three focus groups with 15 patient advocates and three focus groups with 12 practising GPs were conducted before thematic saturation was obtained. Five themes emerged: (1) understanding of PCC is varied and personal, (2) valuing humanistic care, (3) considering the system and collaborating in care, (4) optimising the general practice environment and (5) needing support for PCC that is embedded into training. CONCLUSION: Patient advocates' and GPs' understanding of PCC are diverse, which can hinder strategies to implement and sustain PCC improvements. Future research should explore novel interventions that expose GPs to unique feedback from patients, assess the patient-centeredness of the environment and promote GP self-reflection on PCC.

Putting patients first: development of a patient advocate and general practitioner-informed model of patient-centred care.

BACKGROUND: Patients, providers and health care organisations benefit from an increased understanding and implementation of patient-centred care (PCC) by general practitioners (GPs). This study aimed to evaluate and advance a theoretical model of PCC developed in consultation with practising GPs and patient advocates. METHODS: Qualitative description in a social constructivist/interpretivist paradigm. Participants were purposively sampled from six primary care organisations in south east Queensland/northern New South Wales, Australia. Participants engaged in focus group discussions where they expressed their perceptions, views and feelings of an existing PCC model. Data was analysed thematically using a constant-comparison approach. RESULTS: Three focus groups with 15 patient advocates and three focus groups with 12 GPs were conducted before thematic saturation was obtained. Three themes emerged: i) the model represents the ideal, ii) considering the system and collaborating in care and iii) optimising the general practice environment. The themes related to participants' impression of the model and new components of PCC perceived to be experienced in the 'real world'. The data was synthesised to produce an advanced model of PCC named, "Putting Patients First: A Map for PCC". CONCLUSIONS: Our revised PCC model represents an enhanced understanding of PCC in the 'real world' and can be used to inform patients, providers and health organisations striving for PCC. Qualitative testing advanced and supported the credibility of the model and expanded its application beyond the doctor-patient encounter. Future work could incorporate our map for PCC in tool/tool kits designed to support GPs and general practice with PCC.

A new model of patient-centred care for general practitioners: results of an integrative review.

BACKGROUND: GPs providing patient-centred care (PCC) is embedded in international health care policies due to its positive impact on patients and potential to lower health care costs. However, what is currently known about GP-delivered PCC is unknown. OBJECTIVE: To synthesize literature investigating GP-delivered PCC and address 'what is currently known about GP-delivered PCC?' METHOD: A systematic literature search was conducted between June and July 2018. Eligible articles were empirical, full-text studies published in English between January 2003 and July 2018, related to at least three of the four dimensions of PCC described by Hudon et al. (2011), and related to preventative, acute, and/or chronic care by GPs. Following screening, full-text articles were independently assessed for inclusion by two investigators. Data were extracted and quality assessed by two researchers. Findings on PCC were analysed thematically (meta-synthesis). RESULTS: Thirty medium- to high-quality studies met the inclusions criteria. Included studies utilized varied designs, with the most frequent being quantitative, cross-sectional. A theoretical model of PCC was synthesized from included studies and contained four major components: (i) understanding the whole person, (ii) finding common ground, (iii) experiencing time and (iv) aiming for positive outcomes. Harms of PCC were rarely reported. CONCLUSIONS: Four overarching theoretical components of PCC relate to elements of the consultation and experience of time. These components can be used to inform the development of toolkits to support GPs and general practice organizations in pursuit of PCC as well as tools to measure patient-centredness.

Not just tea and biscuits; the Gold Coast Primary Health Network process of designing, implementing and operating a Community Advisory Council.

Consumers are fast being acknowledged as a critical voice in the creation of sustainable health systems, and their ability and willingness to participate must be kept in mind by those eager to engage them. Federal health reform in Australia has mandated the formal involvement of communities in primary care through advisory committees in the newly established Primary Health Networks. Although there is clear progression towards increased consumer participation in Australia's health services, scope exists to improve the evidence base around identifying and implementing the most appropriate approach in different settings. Gold Coast Primary Health Network has drawn on the principles of deliberative participation to design, implement and operate their Community Advisory Council. Although functioning well, further work is required to evaluate the efficiency of this approach.