Story
Why Primary Care Clinicians use Advice and Guidance: A qualitative study
Key takeaway
A new study finds that doctors are increasingly using advice services to get specialist input, helping them avoid unnecessary patient referrals and improve care.
Quick Explainer
Primary care clinicians use a service called Advice and Guidance to obtain specialist input and support their clinical decision-making. This allows them to efficiently navigate healthcare pathways, avoid unnecessary referrals, and validate their judgments, particularly for complex or uncertain cases. The clinicians' decisions to use this service are driven by factors like the acuity and complexity of the patient's condition, as well as their previous positive or negative experiences with the responsiveness and utility of the specialist advice received. Ensuring timely and clinically relevant specialist responses is crucial for the continued effectiveness of this approach to supporting primary care.
Deep Dive
Technical Deep Dive: Why Primary Care Clinicians use Advice and Guidance
Overview
This study explored why primary care clinicians (PCCs) choose to use Advice and Guidance (A&G) - a service that allows them to seek specialist input to support decision-making and avoid unnecessary referrals. The use of A&G has expanded significantly, accelerated by COVID-19 and contractual changes, but concerns persist regarding workload, responsiveness, and usability. This qualitative study aimed to understand the decision-making processes that underpin PCCs' use of A&G.
Methodology
- 20 semi-structured video interviews were conducted with a purposive sample of primary care clinicians, selected for maximum variation.
- Topic guides were developed with patient and public involvement and refined iteratively.
- Data were analyzed using reflexive thematic analysis within an interpretive description framework.
- Themes were developed collaboratively and refined through discussion with researchers and patient/public contributors.
- The study received ethical approval from the North East Tyne & Wear South Research Ethics Committee.
Key Findings
Four overarching themes emerged regarding PCCs' decisions to use A&G:
- Clinical Presentation:
- Acuity and complexity of the patient's condition influenced whether PCCs sought specialist input via A&G.
- More complex or uncertain cases were more likely to prompt A&G use.
- Navigating Healthcare Pathways:
- PCCs used A&G to help patients access the most appropriate care pathway, avoid unnecessary referrals, and facilitate timely specialist input.
- A&G was seen as a way to "navigate" the healthcare system on behalf of the patient.
- Previous Experiences with A&G:
- Positive past experiences, such as receiving timely and clinically helpful responses, encouraged continued use of A&G.
- Negative experiences, like delayed responses or uncertainty about workload distribution, were barriers to using A&G.
- Validating Clinical Decision-Making:
- PCCs used A&G to confirm their own clinical judgments and decisions, particularly for complex or uncertain cases.
- Seeking specialist input via A&G helped PCCs feel more confident in their management of the patient.
Limitations & Uncertainties
- The study was limited to the English primary care context.
- Participant sampling focused on maximum variation, but the diversity of perspectives may not be fully representative.
- The impact of A&G on patient outcomes was not examined.
- Factors such as practice size, PCC experience level, and specialty interests were not explored in detail.
Conclusion
Primary care clinicians use A&G to support patient care and aid decision-making, but its effectiveness depends on timely, clinically helpful responses from specialists. Ensuring A&G responses remain appropriate to primary care capacity and remit will be essential if A&G becomes the main route into elective care.
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