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A mixed-methods study describing behavioral factors that influenced general practitioners’ experiences using triage during the COVID-19 pandemic

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Lackey, Shaun, Schmidtke, Kelly and Vlaev, Ivo (2021) A mixed-methods study describing behavioral factors that influenced general practitioners’ experiences using triage during the COVID-19 pandemic. BMC Family Practice, 22 . 146. doi:10.1186/s12875-021-01469-x

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Official URL: https://doi.org/10.1186/s12875-021-01469-x

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Abstract

Background
Early in the COVID-19 pandemic, general practices were asked to expand triage and to reduce unnecessary face-to-face contact by prioritizing other consultation modes, e.g., online messaging, video, or telephone. The current study explores the potential barriers and facilitators general practitioners experienced to expanding triage systems and their attitudes towards triage during the COVID-19 pandemic.

Method
A mixed-method study design was used in which a quantitative online survey was conducted along with qualitative interviews to gain a more nuanced appreciation for practitioners’ experiences in the United Kingdom. The survey items were informed by the Theoretical Domains Framework so they would capture 14 behavioral factors that may influence whether practitioners use triage systems. Items were responded to using seven-point Likert scales. A median score was calculated for each item. The responses of participants identifying as part-owners and non-owners (i.e., “partner” vs. “non-partner” practitioners) were compared. The semi-structured interviews were conducted remotely and examined using Braun and Clark’s thematic analysis.

Results
The survey was completed by 204 participants (66% Female). Most participants (83%) reported triaging patients. The items with the highest median scores captured the ‘Knowledge,’ ‘Skills,’ ‘Social/Professional role and identity,’ and ‘Beliefs about capabilities’ domains. The items with the lowest median scores captured the ‘Beliefs about consequences,’ ‘Goals,’ and ‘Emotions’ domains. For 14 of the 17 items, partner scores were higher than non-partner scores. All the qualitative interview participants relied on a phone triage system. Six broad themes were discovered: patient accessibility, confusions around what triage is, uncertainty and risk, relationships between service providers, job satisfaction, and the potential for total digital triage. Suggestions arose to optimize triage, such as ensuring there is sufficient time to conduct triage accurately and providing practical training to use triage efficiently.

Conclusions
Many general practitioners are engaging with expanded triage systems, though more support is needed to achieve total triage across practices. Non-partner practitioners likely require more support to use the triage systems that practices take up. Additionally, practical support should be made available to help all practitioners manage the new risks and uncertainties they are likely to experience during non-face-to-face consultations.

Item Type: Journal Article
Subjects: R Medicine > RC Internal medicine
Divisions: Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Triage (Medicine) -- Great Britain
Journal or Publication Title: BMC Family Practice
Publisher: BioMed Central Ltd.
ISSN: 1471-2296
Official Date: 3 July 2021
Dates:
DateEvent
3 July 2021Published
17 May 2021Accepted
Volume: 22
Article Number: 146
DOI: 10.1186/s12875-021-01469-x
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
RIOXX Funder/Project Grant:
Project/Grant IDRIOXX Funder NameFunder ID
NIHR200165National Institute for Health Research (NIHR)UNSPECIFIED
UNSPECIFIEDApplied Research Centre (ARC) West MidlandsUNSPECIFIED

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