Search

Background: A key role of general practice professionals (that is, GPs, and general practice nurses [GPNs]) is to support patients to change behaviours. Traditional approaches to assisting patients with, and learning about, behaviour change have modest outcomes. Aim: To explore behaviour change with GPs and GPNs and the availability of related professional development (PD) opportunities. Design & setting: Multi-methods study comprising an environmental scan survey of behaviour change tools and PD opportunities, and online workshops with Australian GPs and GPNs. Method: Survey data were analysed using qualitative content analysis, informing the design of the workshops. Workshop data included observation, note-taking, and collaborative reflection, which were analysed thematically and synthesised with survey data. Results: The survey had 18 complete responses. For the two virtual workshops, workshop 1 had 16 participants and workshop 2 had eight participants. There was diversity in awareness of existing behaviour change tools and resources. Preferences for future tools and PD opportunities related to specific aspects of its design, content, activities, and delivery. The following three themes developed from the workshop data: recognising the importance of relationships; recognising the importance of continuity; and keeping context in mind. In the absence of tools and resources, GPs and GPNs discussed behaviour change as something that occurs best through a patient-centred alliance that is continuing, respectful, grounded in trust and an understanding of their patient, and prioritises patient autonomy. Conclusion: Future general practice behaviour change PD should support clinicians to ‘assist’ patients and recognise the social and contextual influences on behaviour. [ABSTRACT FROM AUTHOR]

Objectives: While general practice involves supporting patients to modify their behaviour, General Practitioners (GPs) vary in their approach to behaviour change during consultations. We aimed to identify mechanisms supporting GPs to undertake successful behaviour change in consultations for people with T2DM by exploring (a) the role of GPs in behaviour change, (b) what happens in GP consultations that supports or impedes behaviour change and (c) how context moderates the behaviour change consultation. Methods: Semi-structured interviews with academic clinicians (n = 13), GPs (n = 7) and patients with T2DM (n = 16) across Australia. Data were analysed thematically using a realist evaluation approach. Results: Perspectives about the role of GPs were highly variable, ranging from the provision of test results and information to a relational approach towards shared goals. A GP–patient relationship that includes collaboration, continuity and patient-driven care may contribute to a sense of successful change. Different patient and GP characteristics were perceived to moderate the effectiveness and experience of behaviour change consultations. Discussion: When patient factors are recognised in consultations, a relational approach becomes possible and priorities around behaviour change, that might be missed in a transactional approach, can be identified. Therefore, GP skills for engaging patients are linked to a person-centred approach. [ABSTRACT FROM AUTHOR]

Background: Priority patients in primary care include people from low-income, rural, or culturally and linguistically diverse communities, and First Nations people. Aim: To describe the effectiveness, feasibility, and acceptability of behaviour change tools that have been tested by family doctors working with priority patients. Design and setting: A global systematic review. Method: Five databases were searched for studies published from 2000 to 2021, of any design, that tested the effectiveness or feasibility of tangible, publicly available behaviour change tools used by family doctors working with priority patients. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. Results: Thirteen of 4931 studies screened met the eligibility criteria, and described 12 tools. The health-related behaviours targeted included smoking, diet and/or physical activity, alcohol and/or drug use, and suicidal ideation. Six tools had an online/web/app-based focus; the remaining six utilised only printed materials and/or in-person training. The effectiveness of the tools was assessed in 11 studies, which used diverse methods, with promising results for enabling behaviour change. The nine studies that assessed feasibility found that the tools were easy to use and enhanced the perceived quality of care. Conclusion: Many of the identified behaviour change tools were demonstrated to be effective at facilitating change in a target behaviour and/or feasible for use in practice. The tools varied across factors, such as the mode of delivery and the way the tool was intended to influence behaviour. There is clear opportunity to build on existing tools to enable family doctors to assist priority patients towards achieving healthier lifestyles. [ABSTRACT FROM AUTHOR]

Rationale: Preventive health is a core part of primary care clinical practice and it is critical for both disease prevention and reducing the consequences of chronic disease. In primary care, the 5As framework is often used to guide behaviour change consultations for smoking, nutrition, alcohol use and physical activity. Aims and Objectives: Our objective was to analyze the emphasis placed on each 5As term in commonly used guidelines in Australian general practice and compare this to behaviour change terms/concepts essential to effective consultations. Method: A content analysis was undertaken to explore frequency of 5A terms and key behaviour change concepts/terms chapter‐by‐chapter across the three most commonly used guidelines in Australian general practice. Results: The prevalence of each 5As term differed in all three guidelines, with 'Arrange' being mentioned the least often. Behaviour change concepts and terms, such as patient‐centredness, listening, trust and tailoring, were infrequently used and were often confined to a separate chapter of the guidelines. Conclusion: The language and content of the guidelines contrast with known effective components of behaviour change consultations. Future revisions could reconsider emphasis of 5As terms to avoid paternalistic approaches, improve shared language across guidelines and incorporate behavioural science principles to enhance preventative care delivery. [ABSTRACT FROM AUTHOR]

Demographic changes in Australia have led to an increase in both religious diversity and the number of people who do not nominate a faith affiliation at hospital admission. Models of chaplaincy have shifted from clerical and largely male to an increasingly skilled and diverse spiritual care workforce appointed directly by health services. This study uses survey and in-depth interview methods at an inner-city Australian hospital to examine patient preferences for hospital chaplaincy provided by faith communities, and the importance of faith affiliation compared to other spiritual care provider characteristics. Survey results indicate that of 110 respondents, a high proportion (74%) prefer spiritual care to be provided by a person of the same faith. However, when considered relative to other characteristics, faith affiliation was not as important as kindness, listening skills and a non-judgmental attitude. Our findings have implications for workforce planning and educating. Further research in different settings and with different populations will make the findings more generalizable. [ABSTRACT FROM AUTHOR]

Context: Relational continuity is a core value of primary care. Little is known as to how it can be promoted. EQuIP-GP was a 12-month cluster RCT in 36 practices exploring whether financial incentives can improve relational continuity in general practice (GP). Objective: We examined a) how financial incentives are perceived and experienced by patients and GP teams and b) how routines related to relational continuity are influenced by financial incentives. Study Design: Mixed methods case study. Setting: Maximum variation sample of 6 (2 per state) of the 18 EQuIP-GP intervention practices from the Australian states of New South Wales, Victoria and Tasmania. Population: Each practice provided quantitative data on 30 patients aged =55 and qualitative data from patients, GPs, practice nurses (PN) and practice managers (PM). Intervention: Intervention practices received quality-linked financial incentives for offering longer consultations and early post-hospital review for enrolled patients. Outreach facilitators worked with practices to modify continuity routines. Instruments: Baseline practice attributes survey; Patient Primary Care Assessment Tool (PCAT); semi-structured interviews (13 patients, 10 GPs, 1 PN and 5 PMs). The 3 facilitators collected reflective notes of practice visits and participated in post-study interviews. Outcome Measures: Change in pre-post PCAT relational continuity using paired ttests and one-way ANOVA. Qualitative "practice intervention narratives" helped investigate the response to the intervention and concepts about financial incentives. Results. As with the EQuIP-GP trial, there was no change in relational continuity - PCAT and interview data both suggesting continuity was high at baseline. Participants saw relational continuity as a core component of primary care that should not need incentivising, seeing incentives as a "blunt instrument". Both patients and GPs favoured rewarding, rather than incentivising, quality care. Many felt that Equip-GP's incentive model increased attention to pre-existing routines rather than facilitating new ways of working. Conclusions: While financial incentives can help practices identify how existing routines can influence continuity, incentives for this core component of primary care seem better framed as a reward for good practice rather than an incentive for improvement. Further research could explore these issues in practices with lower baseline continuity of care. [ABSTRACT FROM AUTHOR]