Annette O A Plouvier1, Tim C Olde Hartman1, Clementine E M Verhulst1, Bastiaan R Bloem2, Chris van Weel1,3, Antoine L M Lagro-Janssen1. 1. Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands. 2. Department of Neurology and Parkinson Center Nijmegen, Donders Institute for Brain, Cognition and Behaviour, Radboud university medical center, Nijmegen, The Netherlands. 3. Department Health Services Research and Policy, Australian National University, Canberra, Australia.
Abstract
Background: Specialized Parkinson's disease (PD) care offers advantages to patients. However, specialized health care providers may be unaware of patients' personal context and comorbidity, leading to conflicting treatment regimens. Patients may benefit from a more holistic approach. Objective: To clarify the role community-dwelling PD patients see for general practitioners (GPs) in PD care and to clarify the role GPs see for themselves. Methods: Qualitative interview study with 16 community-dwelling PD patients and 12 GPs in the Netherlands, using a constant comparative approach to analysis. Results: Patients expressed a preference for self-management and autonomy in decision-making. GPs chose a limited, reactive position in early-stage PD care to stimulate patient autonomy. Moreover, GPs felt insufficiently competent to extend their role. Patients also felt GPs lack expert knowledge and skills; they focus on their neurologist for PD care. In addition, GPs observed patients might not realize what accessory role the GP could have, a role GPs described as essential in being aware of patient's well-being. Patients did not describe additional roles for the GP in more advanced disease, whereas GPs mentioned a shift towards a more proactive and extended role. Conclusion: Patients and GPs see a limited role for the GP in early-stage PD care because of patient autonomy and GP's lack of specific knowledge and skills. However, GPs should feel more confident of the added value of their generalist approach to care for patients with a complex chronic disorder as PD. If generalist and specialized care reinforce each other, PD patients benefit.
Background: Specialized Parkinson's disease (PD) care offers advantages to patients. However, specialized health care providers may be unaware of patients' personal context and comorbidity, leading to conflicting treatment regimens. Patients may benefit from a more holistic approach. Objective: To clarify the role community-dwelling PDpatients see for general practitioners (GPs) in PD care and to clarify the role GPs see for themselves. Methods: Qualitative interview study with 16 community-dwelling PDpatients and 12 GPs in the Netherlands, using a constant comparative approach to analysis. Results:Patients expressed a preference for self-management and autonomy in decision-making. GPs chose a limited, reactive position in early-stage PD care to stimulate patient autonomy. Moreover, GPs felt insufficiently competent to extend their role. Patients also felt GPs lack expert knowledge and skills; they focus on their neurologist for PD care. In addition, GPs observed patients might not realize what accessory role the GP could have, a role GPs described as essential in being aware of patient's well-being. Patients did not describe additional roles for the GP in more advanced disease, whereas GPs mentioned a shift towards a more proactive and extended role. Conclusion:Patients and GPs see a limited role for the GP in early-stage PD care because of patient autonomy and GP's lack of specific knowledge and skills. However, GPs should feel more confident of the added value of their generalist approach to care for patients with a complex chronic disorder as PD. If generalist and specialized care reinforce each other, PDpatients benefit.
Authors: Annette O A Plouvier; Tim C Olde Hartman; Olga A de Bont; Sjoerd Maandag; Bastiaan R Bloem; Chris van Weel; Antoine L M Lagro-Janssen Journal: BMC Fam Pract Date: 2017-08-25 Impact factor: 2.497
Authors: Annette O A Plouvier; Tim C Olde Hartman; Anne van Litsenburg; Bastiaan R Bloem; Chris van Weel; Antoine L M Lagro-Janssen Journal: Eur J Gen Pract Date: 2018-12 Impact factor: 1.904
Authors: Herma Lennaerts-Kats; Anne Ebenau; Jenny T van der Steen; Marten Munneke; Bastiaan R Bloem; Kris C P Vissers; Marjan J Meinders; Marieke M Groot Journal: J Parkinsons Dis Date: 2022 Impact factor: 5.568