1. Impaired medical history taking and clinical decision making |
Patient-related factors Barriers Lack of (reliable) health information for triage protocols, history taking, shared decision making, and diagnosis/treatment plan, resulting from difficulty in understanding and communicating various types of health information:
Conveying the reason for encounter Conveying the nature and history of the medical problem Conveying concerns and expectations of the consultation Expressing nuances of complaints Reflecting on feelings and emotions Understanding abstract concepts (for example, time and body functioning) Understanding GP’s questions and explanations of diagnosis and management plan
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Professional-carer-related factors Barriers Lack of (reliable) health information with regard to patient’s condition, medical history, social context, communication level, or reason for encounter; deemed related to:
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Facilitators
Preparing the consultation Attendance of (informed) carer during consultation, preferably family or regular professional carers Use of communication forms Awareness of carers’ roles in providing information during the consultation
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GP-related factors Barriers
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Facilitators Adjustments in communication:
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Adjustments in planning of consultations:
Cutting management plans into smaller pieces during following consultations Scheduling extra consultation time Blocking time slots to allow professional carers to accompany Planning extra telephone consultations with carers absent during the consultation
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Long-term relationship between GP and patient with ID helps to:
Judge reliability of patient information Identify patient’s concerns Understand patient’s communication style Build a trusting relationship with patient
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Long-term relationship between GP and professional carer helps to:
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2. Fragile patient follow-up |
Patient-related factors Barriers
Barriers Lack of information in carer records with regard to diagnosis and management plan; deemed related to:
Absence of carers during the consultation Presence of part-time temporary care staff in the care organisation Lack of competencies in processing health information Inadequate recording and sharing between colleagues
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Mismatch between GPs’ and professional carers’ working hours |
GP-related factors Facilitators
Extra checking of patient’s understanding Provision of information from the consultation in writing and by calling carers at home Explicit requests to professional carers to share and record information Reminders in electronic health records to call patients after ‘no-show’ Notifying intended recipients of professional carer information
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