Background
Methods
Setting
Study design
Participants
Consent
Interview guide
Data collection and analysis
Ethical approval
Results
Chracteristics | n = 44 (%) |
---|---|
Sex
| |
Male
| 27 (63) |
Female
| 16 (37) |
Age group
| |
<30 years
| 2 (4) |
30-44 years
| 21 (48) |
45-59 years
| 18 (41) |
>60 years
| 3 (7) |
Location of GP
| |
Victoria – Metro
| 5 (11) |
Victoria – Rural
| 15 (34) |
New South Wales
| 11 (25) |
Queensland
| 10 (23) |
South Australia
| 3 (7) |
Size of practice (Number of GPs)
| |
≤4
| 25 (57) |
>4
| 19 (43) |
Years in medical practice
| |
<15 years
| 11 (25) |
15-29 years
| 22 (50) |
30+ years
| 11 (25) |
Years in general practice
| |
0-10 years
| 18 (41) |
11-20 years
| 13 (29) |
20-30 years
| 7 (16) |
30+ years
| 6 (14) |
Employment status*
| |
Full time
| 37 (86) |
Part time
| 6 (14) |
Sexual health training
| |
Yes
| 9 (20) |
PNs’ current role in preventative and sexual health
We do a diabetic clinic…a lot of that would cross over into preventative health. Immunisations are preventative as well, they do adult immunisations. GP65 (Rural).A lot of the chronic disease management stuff is semi-preventive in that we are trying to anticipate problems that might arise in future and manage those through things like diet and exercise, appropriate medication, and so on. They do a lot of our vaccinations particularly in flu season. GP1 (Rural).
When it comes to sexual health it would probably be mostly limited to opportunistic prevention during Pap smears because our nurse always takes histories and she does the full deal not just the Pap smear. GP2 (Rural).They mainly do women’s health checks where they do Pap smears. They certainly would offer any screening tests to any women that they thought it might benefit. And I suppose generally we have offered it to anyone under 40 but it depends on people’s lifestyle. GP21 (Rural).
If we can broaden our preventive health campaign to things outside diabetes and ischaemic heart disease then we can incorporate a lot of other different conditions and target healthy people more than we are doing. At the moment we are mainly targeting sick people. GP79 (Rural).We are just about to start a young person’s sexual health clinic. The plan is that she will see patients, take histories and do chlamydia testing. We are just about to expand her role because sexual health is something she does well. GP18 (Rural).
GPs’ support for PN involvement in chlamydia testing and management
I would love to work with a practice nurse who does all our Pap smear and chlamydia tests… I am very happy for that. I worked with nurse practitioners in England I have no objection to them running their own clinics. GP15 (Metro).I think they do have time to spend with patients more than we do, and therefore they can spend more time in explaining the benefits of having something done and also have more time for education and follow-up. GP28 (Rural).
Patients probably don’t find nurses as imposing as speaking to their doctor…speaking to a nurse they might be a bit more comfortable. GP34 (Rural).I think it is easy for a nurse to talk to a patient especially in a younger age group, to talk about such things because patients probably relate a bit more to nurses… they have a more gentle approach. GP60 (Rural).
That is definitely a good idea because we are under pressure for time, so basically if we are running around like always you know they could take part in screening. GP72 (Rural).It is helpful for the patient and doctor as well because sometimes we are so busy. We don’t have enough time to talk preventative health. For us, junior doctors, maybe we have more time but I see the senior doctors, they don’t have enough time. GP70 (Rural).
GPs’ concerns regarding PN involvement in chlamydia management
Funding and remuneration
I think if the government was prepared to let us raise the fee for nurse consultations that reflected the time that they put in we would probably use them for more. A lot of the time at the moment they do things and we get no payment for their time. GP29 (Rural).In places like the UK the nurses are quite active and they do a lot of things themselves…A lot of the things that the nurses could be doing here they don’t do because of billing… we (GPs) get more money if we do it. Definitely the nurses could play more of an active role than they are but I think the reason that that doesn’t happen so much is because of money and billing. GP34 (Rural)
We could do it but then there would have to be funding to actually make sure that we have got enough nurse time available. I don’t know at this stage whether there is an item number for this. It would actually have to be an item number that made it worthwhile financially because we are entirely dependent on the income. GP21 (Rural).Something like the rebate for a Pap smear does not pay for their time…The rebate from memory is about $12 to do a Pap smear and if they are doing a female health check as part of the Pap smear that is a 45 minute consultation, so they are not even paying their wage, so they can’t work independently. So we don’t do it. GP8 (Rural).
The question is should nurses be used that way? They could but it comes back down to who pays and if it is Medicare that pays then I am not so sure that Medicare is very comfortable with nurses initiating that and doctors signing off especially when the doctor is not really involved in the care of that patient. GP26 (Metro).
Workload and time pressures
We see about on an average more than 100 patients a day… we used to have another nurse come in twice a week and she would do all the other things that our main practice nurse wasn’t able to do. She has stopped coming and that has been a terrible loss for us…I think the nurses have a huge role to play and we are probably depriving the community by not having another person to do that sort of thing. GP45 (Rural).Again it is time…She is doing a good job but there are huge loads. Yeah just the transfer of diabetes care into general practice has swamped our nurse. So it leaves little room for chlamydia! GP15 (Metro).
Privacy and confidentiality in small towns
Possibly, I think one of the issues in a small town like ourselves often patients are known and we would just have to be careful that wasn’t a put off for the patients. We would just have to be a little cognisant of the fact that we live in a small community. GP29 (Rural).
I am not sure about that (partner notification). I think is a difficult thing. There are issues involved with that as far as confidentiality. If a person has only got one partner and then you ring them up and say, “You know we want to follow you up we think you both have had some chlamydia contact,” well it is pretty obvious who the person is that has been here. GP28 (Rural).I think it gets a bit difficult because in a country town … one of our nurses had four children here and they went to the local high school so their children know a lot of people in town and I think it would be a bit awkward if you had to ring up someone and said, “Look you know…” And medico-legally I mean confidentiality I always sort of worryabout. GP4 (Rural).
Education and training for PNs
I think they should have proper knowledge of chlamydia… how can we treat it and do we have to do any follow up after? If it’s complicated chlamydia like PID, what is the management? They should know more about it so they can give proper health education to the patients. GP20 (Rural).Nurses could organise urine testing or swabbing, they are very unlikely to want to organise swabbing because that requires the skills necessary for doing virtually the equivalent of a Pap smear and some nurses are comfortable with that and some are not. But look they can be trained; it is undoubtedly easy to train anyone up to that standard. GP26 (Metro).I think they should be specifically trained to do that. I think if the approach is on sexually transmitted infections I think they would need to be trained for that, the way they approach them, how they go about the investigations. GP39 (Metro).