Lost in translation? Paradigm conflict at the primary–secondary care interface

Johnston, Jennifer; Bennett, Deirdre

doi:10.1111/medu.13758

Cited by 34 publications

(36 citation statements)

References 25 publications

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“…It is described that lack of respect from SCDs hindered PCDs in their collaborative practice [ 69 ]. An underlying cause may be the different paradigms that reign in primary and secondary care respectively [ 70 ]. In our review participants from both primary and secondary care emphasised the importance of a collaborative, respectful attitude.…”

Section: Discussionmentioning

confidence: 99%

Competencies to promote collaboration between primary and secondary care doctors: an integrative review

Janssen

Sagasser²,

Fluit

et al. 2020

BMC Fam Pract

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Background In a society where ageing of the population and the increasing prevalence of long-term conditions are major issues, collaboration between primary and secondary care is essential to provide continuous, patient-centred care. Doctors play an essential role at the primary-secondary care interface in realising ‘seamless’ care. Therefore, they should possess collaborative competencies. However, knowledge about these collaborative competencies is scarce. In this review we explore what competencies doctors need to promote collaboration between doctors at the primary-secondary care interface. Methods We conducted an integrative literature review. After a systematic search 44 articles were included in the review. They were analysed using a thematic analysis approach. Results We identified six themes regarding collaborative competencies: ‘patient-centred care: a common concern’, ‘roles and responsibilities’, ‘mutual knowledge and understanding’, ‘collaborative attitude and respect’, ‘communication’ and ‘leadership’. In every theme we specified components of knowledge, skills and attitudes as found in the reviewed literature. The results show that doctors play an important role, not only in the way they collaborate in individual patient care, but also in how they help shaping organisational preconditions for collaboration. Conclusions This review provides an integrative view on competencies necessary for collaborative practice at the primary-secondary care interface. They are part of several domains, showing the complexity of collaboration. The information gathered in this review can support doctors to enhance and learn collaboration in daily practice and can be used in educational programmes in all stages of medical education.

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Section: Discussionmentioning

confidence: 99%

Competencies to promote collaboration between primary and secondary care doctors: an integrative review

Janssen

Sagasser²,

Fluit

et al. 2020

BMC Fam Pract

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“…Because of the relatively small risk of progression to end‐stage renal disease, combined with the high prevalence of early stage CKD in higher age groups, with over 90% of persons with CKD 3–5 being aged 65 and over, there has been some discussion about monitoring and treatment intensity and appropriate referral criteria to nephrologists for this population (Australian Institute of Health & Welfare, 2018; Glassock, Delanaye, & Nahas, ; Moynihan, Glassock, & Doust, ). Research suggests, that specialists expect benefit from cooperating with GPs regarding the regulation of patient flow, but do not always consider GPs as equals with respect to professional expertise, and instead wish to transfer knowledge to GPs (“teaching the GP”) (Berendsen et al, ; Johnston & Bennett, ). Sampson, Barbour, and Wilson () found, that perceived inappropriate transfer of workload and unrealistic expectations between physicians are aspects that could potentially negatively influence the relationship between primary and secondary care doctors.…”

Section: Introductionmentioning

confidence: 99%

Nephrologists’ perspectives on ambulatory care of patients with non‐dialysis chronic kidney disease ‐ A qualitative study

Haase

Stracke²,

Chenot

et al. 2019

Health Soc Care Community

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Little is known on the perspectives of nephrologists on managing non-dialysis patients with chronic kidney disease (CKD). The purpose of this qualitative study was to explore the experiences and perspectives of nephrologists regarding the interface with general practitioners (GP) and GPs' management of patients with non-dialysis CKD, so that barriers to cooperation and need for improved management can be identified. Twenty semi-structured interviews were conducted for this qualitative study. The interviews were audio-recorded and coded to be analysed. The concept of knowledge systems served as a sensitising concept. Optimising underlying diseases, medication adaptation and patient awareness of CKD were regarded as the most important treatment measures in CKD management. Differing views exist on who should be responsible for lifestyle interventions, patient education and timing of referral. Nephrologists generally preferred the referral of patients with high progression risk and co-treatment models in which daily care was performed by GP, but some preferred referral of all patients with early CKD and some nephrologists stated that patient care should be in the hands of nephrologists entirely in case of CKD. Doctorpatient communication predominantly remained within the medical-scientific knowledge system whereas patients' everyday knowledge systems were rarely considered. While stressing optimisation of laboratory values, diabetes and hypertension, patients' perspectives and shared decision-making to identify and prioritise patients' individual health goals were rarely considered by nephrologists. Instead, most nephrologists regarded educating patients and GPs as an important part of their professional role. Defining the interface between GPs and nephrologists, with specific recommendations on when to refer and which tasks each professional group should perform can lead to standardisation and improved interdisciplinary management of CKD patients. Addressing patients' everyday knowledge systems can be valuable in formulating and prioritising health goals with patients. K E Y W O R D S chronic kidney disease, interdisciplinary care, nephrology care, primary secondary care interface, qualitative study | e439 HAASE Et Al.

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“…Three papers in this issue, although they vary in subject matter and approach, exemplify the challenges of medical education, positioned as it is at the intersection of so many boundaries. One paper addresses the tension between clinical specialties, a second discusses the age‐old conflict between education and service, and a third focuses on how individual teachers navigate the territory between vulnerability and credibility in their day‐to‐day contact with students …”

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confidence: 99%