Frequent attenders in primary health care: a mixed-methods study of patient and staff perspectives.

AIMS AND OBJECTIVE: To understand the frequent attendance phenomenon from the perspective of patients and healthcare professionals and how it can be reduced. BACKGROUND: Frequent attenders (FAs) are characterised by the consumption of a disproportionate number of medical consultations and a high number of visits per year to primary care physicians (PCP). Although FAs constitute about 10% of all primary clinic attendees, they are responsible for ~40-50% of clinic visits, affecting the efficiency, accessibility and quality of health services provided to other patients. DESIGN: Mixed methods (STROBE Statement: Data S1; COREQ checklist: Data S2). METHODS: Eighteen FAs were interviewed in a qualitative approach. PCPs and nurses (n = 184) completed a cross-sectional survey. RESULTS: FAs are driven by their personal, emotional and mental state. FAs viewed clinics as a source for information and resolving medical problems. They perceived PCPs as authoritative and knowledgeable, and nurses as treatment managers and mediators between PCPs and patients. In contrast, FAs evoked more negative emotions than positive ones among medical staff. PCPs and nurses attributed frequent visits to FAs' personal and emotional states. A model based on the findings was constructed to provide a framework for grasping frequent attendance from a sociological perspective and for planning and managing it. CONCLUSIONS: The accessibility and availability of health services at primary clinics, and collaboration and trust in medical staff facilitate the frequent attendance phenomenon. RELEVANCE TO CLINICAL PRACTICE: The frequent attendance phenomenon should be proactively prevented, even before patients become FA, using the model constructed, which serves as a foundation for introducing an intervention program to identify and prevent frequent attendance. PCPs and nurses working in primary care clinics should be made aware of the FA phenomenon and should be educated and given tools to deal with it within the clinic. The process should be facilitated by organisational support. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution to the design or conduct of the study, analysis or interpretation of the data, or in the preparation of the manuscript.

Motivations and challenges of Israeli nurses on their journey to a PhD: A qualitative study.

AIM: This qualitative study aimed to examine the motivations and challenges encountered by Israeli nurses during their journey to achieve a doctoral degree (PhD). BACKGROUND: The increasing numbers of nurses studying for a doctoral degree may contribute to improving nursing education, expanding the body of knowledge and promoting the status of nursing as a research profession. However, many countries have reported a shortage in nurses with doctoral degrees. DESIGN: Qualitative content analysis study using semi-structured interviews. METHODS: Sixteen senior nurses (mean age 47.35 years, 75% women) who completed their doctoral studies in the past five years were interviewed. The interviews were transcribed and their content was analyzed inductively. COREQ checklist was used to report the study. RESULTS: The ability to persevere in doctoral studies was related to the support provided by the learning environment as well as to family support. External barriers were related to administrative bureaucracy, tedious search for a mentor, unsupportive workplace and socio-economic burdens. PhD studies were perceived as a means for self-fulfillment, while major motivators were aspiration for professional advancement, a responsibility for promoting the image of nursing and a lack of recognition by colleagues. CONCLUSIONS: Nurses study for doctoral degrees in order to advance their career and achieve personal fulfillment, as well as to increase the prestige of the nursing as profession. To allow nurses with PhD to fulfill their abilities and to advance the nursing profession, their research and academic support should be increased, and appropriate professional positions should be developed. TWEETABLE ABSTRACT: This study highlights the facilitators of doctoral studies such as family and academic support, a strong need for personal and professional fulfillment, and a desire for professional change, and obstacles such as academic and bureaucratic barriers, low wage increases, and a lack of recognition of nursing by the medical world.