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General practitioners' role in improving health care in care homes: a realist review

Chadborn, Neil H.; Devi, Reena; Goodman, Claire; Williams, Christopher D.; Sartain, Kate; Gordon, Adam L.

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Authors

Reena Devi

Claire Goodman

Christopher D. Williams

Kate Sartain

ADAM GORDON Adam.Gordon@nottingham.ac.uk
Professor of The Care of Older People



Abstract

Background:

Despite recent focus on improving health care in care homes, it is unclear what role general practitioners (GPs) should play. To provide evidence for future practice we set out to explore how GPs have been involved in such improvements.

Methods:

Realist review incorporated theory-driven literature searches and stakeholder interviews, supplemented by focussed searches on GP-led medication reviews and end-of-life care. Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library were searched. Grey literature was identified through internet searches and professional networks. Studies were included based upon relevance. Data were coded to develop and test contexts, mechanisms, and outcomes for improvements involving GPs.

Results:

Evidence was synthesized from 30 articles. Programme theories described: (i) "negotiated working with GPs," where other professionals led improvement and GPs provided expertise; and (ii) "GP involvement in national/regional improvement programmes." The expertise of GPs was vital to many improvement programmes, with their medical expertise or role as coordinators of primary care proving pivotal. GPs had limited training in quality improvement (QI) and care home improvement work had to be negotiated in the context of wider primary care commitments.

Conclusions:

GPs are central to QI in health care in care homes. Their contributions relate to their specialist expertise and recognition as leaders of primary care but are challenged by available time and resources to develop this role.

Citation

Chadborn, N. H., Devi, R., Goodman, C., Williams, C. D., Sartain, K., & Gordon, A. L. (2022). General practitioners' role in improving health care in care homes: a realist review. Family Practice, 40(1), 119-127. https://doi.org/10.1093/fampra/cmac071

Journal Article Type Article
Acceptance Date May 30, 2022
Online Publication Date Jul 4, 2022
Publication Date Jun 4, 2022
Deposit Date Jun 16, 2022
Publicly Available Date Mar 29, 2024
Journal Family practice
Print ISSN 0263-2136
Electronic ISSN 1460-2229
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 40
Issue 1
Pages 119-127
DOI https://doi.org/10.1093/fampra/cmac071
Keywords End-of-life care, general practice, long-term care facilities, medication review and optimization, nursing homes, quality improvement
Public URL https://nottingham-repository.worktribe.com/output/8499214
Publisher URL https://academic.oup.com/fampra/article/40/1/119/6628701?login=false

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