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      Patient experiences during the COVID-19 pandemic: a qualitative study in Dutch primary care

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          Abstract

          Background

          Changes in primary care provision during the COVID-19 pandemic could have affected patient experience of primary care both positively and negatively.

          Aim

          To assess the experiences of patients in primary care during the COVID-19 pandemic.

          Design & setting

          A qualitative study of patients from regions with high and low COVID-19 prevalence in the Netherlands.

          Method

          A qualitative study using a phenomenological framework was performed among purposively sampled patients. Individual semi-structured interviews were performed and transcribed. Data were thematically analysed by means of an inductive approach.

          Results

          Twenty-eight patients were interviewed (13 men and 15 women, aged 27–91 years). After thematic analysis, two main themes emerged: accessibility and continuity of primary care. Changes considered positive during the pandemic regarding accessibility and continuity of primary care included having a quieter practice, having more time for consultations, and the use of remote care for problems with low complexity. However, patients also experienced decreases in both care accessibility and continuity, such as feeling unwelcome, the GP postponing chronic care, seeing unfamiliar doctors, and care being segregated.

          Conclusion

          Despite bringing several benefits, patients indicated that the changes to primary care provision during the COVID-19 pandemic could have threatened care accessibility and continuity, which are core values of primary care. These insights can guide primary care provision not only in this and future pandemics, but also when implementing permanent changes to care provision in primary care.

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          Most cited references38

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Contribution of primary care to health systems and health.

            Evidence of the health-promoting influence of primary care has been accumulating ever since researchers have been able to distinguish primary care from other aspects of the health services delivery system. This evidence shows that primary care helps prevent illness and death, regardless of whether the care is characterized by supply of primary care physicians, a relationship with a source of primary care, or the receipt of important features of primary care. The evidence also shows that primary care (in contrast to specialty care) is associated with a more equitable distribution of health in populations, a finding that holds in both cross-national and within-national studies. The means by which primary care improves health have been identified, thus suggesting ways to improve overall health and reduce differences in health across major population subgroups.
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              Thematic analysis of qualitative data: AMEE Guide No. 131

              Thematic analysis is a widely used, yet often misunderstood, method of qualitative data analysis. It is a useful and accessible tool for qualitative researchers, but confusion regarding the method's philosophical underpinnings and imprecision in how it has been described have complicated its use and acceptance among researchers. In this Guide, we outline what thematic analysis is, positioning it in relation to other methods of qualitative analysis, and describe when it is appropriate to use the method under a variety of epistemological frameworks. We also provide a detailed definition of a theme, as this term is often misapplied. Next, we describe the most commonly used six-step framework for conducting thematic analysis, illustrating each step using examples from our own research. Finally, we discuss advantages and disadvantages of this method and alert researchers to pitfalls to avoid when using thematic analysis. We aim to highlight thematic analysis as a powerful and flexible method of qualitative analysis and to empower researchers at all levels of experience to conduct thematic analysis in rigorous and thoughtful way.
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                Author and article information

                Journal
                BJGP Open
                BJGP Open
                bjgpoa
                bjgpoa
                BJGP Open
                Royal College of General Practitioners
                2398-3795
                December 2022
                30 November 2022
                30 November 2022
                : 6
                : 4
                : BJGPO.2022.0038
                Affiliations
                [1 ] deptDepartment of General Practice and Elderly Care Medicine , University of Groningen, University Medical Center Groningen (UMCG) , Groningen, The Netherlands
                [2 ] deptDepartment of Primary and Community Care , Radboud University Nijmegen Medical Center, Radboud institute of Health Sciences , Nijmegen, The Netherlands
                [3 ] Nivel, Netherlands Institute for Health Services Research (Nivel) , Utrecht, The Netherlands
                [4 ] deptTilburg School of Social and Behavioral Sciences , Tilburg University , Tilburg, The Netherlands
                [5 ] Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Midwifery Science, AVAG, Amsterdam Public Health , Amsterdam, The Netherlands
                Author notes
                *For correspondence: Maarten Homburg, t.m.homburg@ 123456umcg.nl
                Author information
                https://orcid.org/0000-0002-3295-4656
                http://orcid.org/0000-0003-2078-1206
                Article
                0038
                10.3399/BJGPO.2022.0038
                9904784
                36270671
                e8e2d045-bdd0-4566-b424-71dd98b27026
                Copyright © 2022, The Authors

                This article is Open Access: CC BY license ( https://creativecommons.org/licenses/by/4.0/)

                History
                : 23 March 2022
                : 12 August 2022
                : 09 September 2022
                Categories
                Research
                Custom metadata
                InDesignSetterCC
                1666044025947
                Affiliation 1 was changed
                Affiliation 2 was changed
                Affiliation 3 was changed
                Affiliation 5 was changed
                Figure 1 was changed
                Affiliation 4 was changed
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                continuity of patient care,health services accessibility,primary health care,covid-19,healthcare utilisation

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