The GP population
At the time of the research (2019), the Valenciennois-Quercitain area had around 31 520 inhabitants aged ≥75 years, 350 GPs, 148 community pharmacies, 390 community nurses, five social care networks (local information and coordination centres), and several home help services for older adults.
Of the 350 GPs based in the Valenciennois-Quercitain area, 139 had completed ≥3 PAERPA PHPs (the GP+ group) and 141 GPs had declined to participate in the PAERPA ICP (the GP–group). Lastly, 70 GPs had carried out <3 PHPs and so were not analysed further.
Results of the qualitative study
In the GP+ group, 16 of the 139 GPs were contacted. Twelve interviews were required for the collection of sufficient data. In the GP–group, 39 of the 141 GPs were contacted. Again, 12 interviews were required for the collection of sufficient data. The characteristics of the GPs interviewed and the duration of the interviews are summarised in Supplementary Table S1.
The analysis of the interviews with the GP+ and GP–groups identified four main common themes. For each theme, the GP+ and GP–groups differed diametrically in their feelings about integrated care and care for older people (Box 1). The subnodes from the coding tree are in Supplementary Figures S1 and S2.
| GPs who participated in the PAERPA integrated care project (GP+ group) | GPs who declined to participate in the PAERPA integrated care project (GP–group) |
|---|
| • Aware of issues in care of older adults and the value of collaborative work | • Lack of awareness of issues pertaining to care of older adults, and reluctance to work collaboratively |
| • Involvement in an integrated care pathway saves time | • Involvement to an integrated care pathway would be a waste of time |
| • Interest in delegating tasks | • Task delegation is considered as an intrusion into the physician–patient relationship |
| • Coordination has benefits | • The presence of a coordinator is viewed as a form of control over the physicians’ activities |
Box 1. Results of the qualitative analysis of GPs’ reasons for participating or declining to participate in the PAERPA integrated care project
The theory developed by the steering committee was based on the central role of awareness of older age care issues from which the perceptions of GP+ and GP–could be derived. The schematic diagram is provided in Supplementary Figure S3.
The participants in the GP+ group were aware of the complex issues in care of older people and considered that networking was a good way of tackling this complexity. In contrast, the members of the GP–group were not interested in care of older people and did not believe in the value of networking:
‘… there are people who will have [...] skills that I don’t [...] I consider that they will add something to an area in which I am not competent.’
(GP+ group, GP8, aged 58 years)
‘It [networking] also gave us an overview. From a social and administrative point of view [...] I was very interested in that.’
(GP+ group, GP7, aged 43 years)
‘Geriatrics doesn’t interest me much [...] I’ve had it, I’m sick of it.’
(GP–group, GP19, aged 63 years)
‘All these networks, it’s nonsense. And anyway, they are never there when you need them.’
(GP–group, GP24, aged 37 years)
The interviewees in the GP+ group considered that their participation in an integrated care pathway would save them time thanks to the presence of the care coordinator. Indeed, they reported they saved time because the care coordinator undertook tasks in coordination, communication, and administrative support. The members of the GP–group considered that participation would increase their workload to an unacceptable extent:
‘I don’t think it’s feasible without a local coordinator because they coordinate the care and bind it all together [...] Because we can’t actually spend 2 hours coordinating with the nurse and spending 2 hours on that; it was impossible, it doesn’t fit into a GP’s schedule at the moment.’
(GP+ group, GP6, aged 49 years)
‘She [the care coordinator] made my work easier, in fact — fortunately so because it takes a lot of energy otherwise.’
(GP+ group, GP4, aged 52 years)
‘It’s a system that seemed very time-consuming to me. That’s what scared me.’
(GP–group, GP15, aged 60 years)
‘I believe that the extra work would have been impossible to do, given my workload.’
(GP–group, GP23, aged 43 years)
The GPs in the GP+ group liked the task delegation in general and particularly with regard to the tasks taken on by the care coordinator. The members of the GP–group considered this delegation to be a form of direct intrusion into the physician–patient relationship:
‘She [the care coordinator] does everything. I have to say it, she fills me in on everything. We just go over it point by point, we look together at what was targeted. But everything is filled in, I don’t have to do any extra paperwork, I don’t have an additional administrative workload.’
(GP+ group, GP12, aged 62 years)
‘What I liked was that the PAERPA project formalised a network that already existed.’
(GP+ group, GP9, aged 30 years)
‘So I didn’t wait for the PAERPA project to take care of my patients.’
(GP–group, GP16, aged 42 years)
‘And, in the end … the people [patients] who chose us as their GP have the impression that they have a rapport with us — there is intimacy, the confidentiality of the physician–patient relationship — and that this universe of intimacy is open to everyone.’
(GP–group, GP21, aged 51 years)
The GP+ group appreciated the benefits of coordination in general and the role of the care coordinator in particular. The GP–group viewed coordination as a form of activity monitoring or a devaluation of their skills:
‘I work on the principle that the more people we look at, the more things we see. The more people [caregivers] there are, the better it goes.’
(GP+ group, GP8, aged 57 years)
‘It’s an advantage because it’s much more practical, it centralises more things, and above all it’s very easy to contact [the coordinator] .’
(GP+ group, GP12, aged 62 years)
‘We are falling into a system, under the guise of prevention. We must not delude ourselves — they are trying to control us [...] I think there are organisations trying to surround us, to close us in.’
(GP–group, GP13, aged 45 years)
‘We are not being stifled, well, a little ... It’s guilt-driven: why didn’t he do that, why didn’t he call them? And, um, no, we’re managing alright.’
(GP–group, GP13, aged 45 years)
