Lieve Peremans

Contraceptive knowledge and expectations by adolescents: an explanation by focus groups.

To determine the needs and expectations of adolescent girls concerning contraceptive use as well as their attitude to health care providers, a qualitative research was performed with four focus groups of 17-year-old girls of different education levels. All 26 girls except one were of Belgian origin. There was a fixed scenario for each group. The discussions were tape-recorded, transcribed and analysed via content analysis. Knowledge concerning the daily use and side-effects of contraceptives was insufficient. A school physician is not the person they want to talk to. The influence of the peer in the group is very important. The general practitioner is the most frequently consulted health care provider for the first pill prescription, but for a gynaecological examination they thought they had to visit a gynaecologist. The girls expected confidentiality from their general practitioner and wanted sufficient consultation time. Factors inhibiting the visits for obtaining contraceptives were the cost, waiting time and fear of the gynaecological examination. Adolescents intended to visit their general practitioner for contraceptives, but the family practice had to be easily accessible. It is a challenge for general practitioners to provide good contraceptives to adolescents and to promote compliance.

The research agenda for general practice/family medicine and primary health care in Europe. Part 3. Results: Person centred care, comprehensive and holistic approach

Abstract The recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In a second article, the results for the two core competencies ‘primary care management’ and ‘community orientation’ were presented. This article reflects on the three core competencies, which deal with person related aspects of GP/FM, i.e. ‘person centred care’, ‘comprehensive approach’ and ‘holistic approach’. Though there is an important body of opinion papers and (non-systematic) reviews, all person related aspects remain poorly defined and researched. Validated instruments to measure these competencies are lacking. Concerning patient-centredness, most research examined patient and doctor preferences and experiences. Studies on comprehensiveness mostly focus on prevention/care of specific diseases. For all domains, there has been limited research conducted on its implications or outcomes.

The Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe. Part 1. Background and methodology 1

Abstract At the WONCA Europe conference 2009 the recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ was presented. The Research Agenda is a background paper and reference manual for GPs/ family doctors, researchers and policy makers, providing advocacy of general practice/family medicine GP/FM in Europe. The Research Agenda summarizes the evidence relating to the core competencies and characteristics of the WONCA Europe definition of GP/FM, and its meaning for researchers and policy makers. Evidence gaps and research needs are pointed out to provide a basis for planning research for which there is a need and for action that may influence health and research policy, i.e. applying/lobbying for research funds. WONCA Europe and its associated networks and special interest groups could consider the agendas research priorities when planning future conferences, courses, or projects, and for funding purposes. The European Journal of General Practice will publish a series of articles based on this document. In this first article, background, objectives, methodology and relevant literature are discussed. In subsequent articles, the results will be presented.

The critical appraisal of focus group research articles

Background: Focus group discussions are becoming an increasingly popular methodology in primary healthcare research. They can be used to understand peoples beliefs, opinions and attitudes about the topic of interest. With the increasing emphasis on critical appraisal of scientific research, it is obvious that reporting qualitative research has to be transparent. Not only should the methodology itself be easy to understand and evaluate, but also the question whether focus group methodology is the most appropriate way to serve the research question should be answered. Focus group discussions are relatively new to biomedical journals, often resulting in misunderstanding and frustration for authors, reviewers and editors. Objectives: To develop a reliable and valid checklist for the critical appraisal of focus group research articles for the information of referees and editors of medical journals, commissioners of research, but most of all to help authors to report transparently. Methods: A review of the literature in different databases from 1990 to 2000 using the keywords “qualitative research”, “focus groups”, “methodology” and “standards” resulted in a checklist being issued. This checklist was submitted to an expert panel, its feasibility was addressed and the inter-rater agreement was assessed by members of the European General Practice Research Workshop. Results: A critical appraisal checklist for focus group research articles. Conclusions: The checklist does not replace training in the research method but it can act as a tool for authors, reviewers, editors and commissioners of research.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: Specific problem solving skills

Abstract The ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on ‘primary care management’ and ‘community orientation’ and the person-related core competencies of GP/FM. This article reflects on the general practitioners ‘specific problem solving skills’. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that ‘usual care’ by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.

Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 5: Needs and implications for future research and policy

The European General Practice Research Network (EGPRN) has provided the discussions on priorities in research in general practice/family medicine (GP/ FM) and primary health care (PHC) with an important background document. In this issue the conclusions are presented, framing a broad perspective for setting the future research agenda (1). It will be strategically important to defi ne some spearheads that may guide priority setting for the next decade. The following principles could be used to underpin the debate: relevance, equity, quality, cost effectiveness, sustainability, person-centeredness, and innovation.AbstractThe recently published ‘Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe’ summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competenci...

Conceptualizing collaboration between children's services and child and adolescent psychiatry: A bottom-up process based on a qualitative needs assessment among the professionals

Little is known about the need of professionals of children’s services and child and adolescent psychiatry to collaborate. This study aimed to explore the perception of practitioners of both services with regard to a future collaborative partnership improving the wellbeing of children in children’s services. Eight focus groups were performed and analysed, following the principles of the Grounded Theory. The focus groups revealed that the professionals agree considerably concerning the outlines of the collaboration. They agree upon the primary goal of the partnership, their expected role and tasks. In addition, the partnership should develop in an atmosphere of mutual respect and with the intention to provide the best care for the child. The results of the focus groups are discussed in consideration of a future implementation of interventions on developing best practices at the intersection of children’s services and child and adolescent psychiatry.

What factors determine Belgian general practitioners' approaches to detecting and managing substance abuse? A qualitative study based on the I-Change Model.

BackgroundGeneral practitioners (GPs) are considered to play a major role in detecting and managing substance abuse. However, little is known about how or why they decide to manage it. This study investigated the factors that influence GP behaviours with regard to the abuse of alcohol, illegal drugs, hypnotics, and tranquilisers among working Belgians.MethodsTwenty Belgian GPs were interviewed. De Vries’ Integrated Change Model was used to guide the interviews and qualitative data analyses.ResultsGPs perceived higher levels of substance abuse in urban locations and among lower socioeconomic groups. Guidelines, if they existed, were primarily used in Flanders. Specific training was unevenly applied but considered useful. GPs who accepted abuse management cited strong interpersonal skills and available multidisciplinary networks as facilitators.GPs relied on their clinical common sense to detect abuse or initiate management. Specific patients’ situations and their social, psychological, or professional dysfunctions were cited as cues to action.GPs were strongly influenced by their personal representations of abuse, which included the balance between their professional responsibilities toward their patients and the patients’ responsibilities in managing their own health as well the GPs’ abilities to cope with unsatisfying patient outcomes without reaching professional exhaustion. GPs perceived substance abuse along a continuum ranging from a chronic disease (whose management was part of their responsibility) to a moral failing of untrustworthy people. Alcohol and cannabis were more socially acceptable than other drugs. Personal experiences of emotional burdens (including those regarding substance abuse) increased feelings of empathy or rejection toward patients.Multidisciplinary practices and professional experiences were cited as important factors with regard to engaging GPs in substance abuse management. Time constraints and personal investments were cited as important barriers.Satisfaction with treatment was rare.ConclusionsMotivational factors, including subjective beliefs not supported by the literature, were central in deciding whether to manage cases of substance abuse. A lack of theoretical knowledge and training were secondary to personal attitudes and motivation. Personal development, emotional health, self-awareness, and self-care should be taught to and fostered among GPs to help them maintain a patient-centred focus. Health authorities should support collaborative care.

The development of research capacity in Europe through research workshops—the EGPRN perspective

The academic development of the domain of General Practice and family medicine (FM) has made notable progress recently, but one should never rest on one’s laurels. Continuing progress requires a strong research base for the discipline, which is still weak both in terms of evidence, with relatively few publications from primary care, and in the limited number of research institutes around the world. Ironically, even though the evidence for primary care in health care systems is rather strong and international political support has been repeatedly promised, the spirit of Alma Ata seems not to have been realized and governments seem to be more supportive of investment in secondary and tertiary care. The key to development as an independent specialist discipline is the development of an independent research base to define the characteristics of the domain, to support clinical work and to inform educational and professional development. Primary care researchers have to go beyond the agenda of public health and secondary care and carry out research into the content and delivery of primary care and into diagnosis in primary care. What does research in general practice/FM entail? The researcher may be a clinician with a special interest, a student who is preparing a dissertation for a University degree or a researcher from a field outside medicine. A research question is developed, and with some advice, an appropriate methodology is selected (such as a questionnaire to fellow clinicians, a study of patient records or an intervention to improve practice). The novice researcher will benefit enormously from expert advice at this stage since errors in research question development or methodology for data collection may make the project untenable at a later stage. Successful completion of the project may result in obtaining a degree, improving practice at a local or regional setting in a specific domain or national or international publication of a paper and the start of a new academic career in parallel or instead of a purely clinical one. Successful publication will make access to research grants and/or career posts, and further publication, more likely.

How does a Belgian health care provider deal with a request for emergency contraception

Objective To evaluate how Belgian health care providers deal with a request for emergency contraception. Method In 2002–2003 we conducted 12 focus groups with pharmacists, general practitioners and school physicians. A skilled moderator accompanied by an observer conducted the focus groups using a semi-structured screenplay. Results All these health care providers agree with the free access to emergency contraception (EC), but experience considerable frustration with regard to the practical aspects and the legal framework. General practitioners (GPs) claim to spend a lot of time on requests for EC and they are concerned about the quality of the counselling provided in pharmacies. Pharmacists are creative when giving counselling in the pharmacy, but there is, nevertheless, a problem with a lack of privacy. School physicians are frustrated that there is no legal possibility to respond to a request for EC when they feel they are ideally placed to advise adolescents. Conclusion The over-the-counter sale of EC offers women better access, but many barriers still interfere with optimal care. Pharmacists experience a lack of skills to communicate with adolescents and a lack of privacy to give counselling. GPs have good intentions, but are confronted with a lack of willingness on the part of the patients and also financial barriers. School physicians want more possibilities to help adolescents.