RT Journal Article
SR Electronic
T1 Disruption to the doctor-patient relationship in primary care: a qualitative study
JF BJGP Open
JO BJGP Open
FD Royal College of General Practitioners
SP BJGPO.2022.0039
DO 10.3399/BJGPO.2022.0039
A1 Kyle Eggleton
A1 Nam Bui
A1 Felicity Goodyear-Smith
YR 2022
UL http://bjgpopen.org/content/early/2022/08/04/BJGPO.2022.0039.abstract
AB Background Starfield describes importance of system-level components of primary care (first-contact, continuous, comprehensive, coordinated), on countries’ health systems. We postulate at the individual-level, interpersonal interactions and relationship-centred care are central to primary care.Aim Explore impact of COVID-19 on disruption to doctor-patient relationship and subsequent development of new models of care.Design & setting Series of 11 cross-sectional ‘surveys of New Zealand urban and rural primary care doctors, nurses and managers, May 2020 to February 2021, to understand and monitor responses to pandemic.Method Using inductive content analysis, cumulated qualitative data from doctors was examined through the lenses of doctor-patient relationship, its disruption and resulting changes in models of care.Results 1519 responses representing 482 unique participants, 86% doctors. Four key themes of move to transactional consultations; task shifting with team changes; creating a production line; and diminished communication and coordination across services emerged.Conclusion Advent of pandemic led to severe and ongoing strain on practices requiring rapid change to model of care. Team members took on new roles for triaging, testing and separating respiratory from non-respiratory patients. Rapid move to telehealth, with policies developed on where face-to-face consultations necessary. Practice strain exacerbated by disruption to coordination with secondary and other referral services. As new models of general practice develop, further disruptions to development of doctor-patients relationships must be avoided. This work extends Starfield’s system-level paradigm to the individual level with the core value of primary care the doctor-patient relationship. Successful sustainable models likely to be where relationships are centralised.