Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners

  • Lucia Zannini | lucia.zannini@unimi.it University of Milano, Italy.
  • Cesarina Cattaneo University of Milano, Italy.
  • Paolo Peduzzi University of Milano, Italy.
  • Silvia Lopiccoli ASL Monza Brianza, Italy.
  • Francesco Auxilia Section of Public Health, Department of Biomedical Sciences for Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore di Milano, Italy.

Abstract

Background. Clinical governance is considered crucial in primary care. Since 2005, clinical pathways have been experimentally implemented at the Local Health Authority of Monza Brianza (ASLMB), Italy, to develop general practitioners’ (GPs) care of patients affected by some chronic diseases. The experimentation was aimed at introducing clinical governance in primary care, increasing GPs’ involvement in the care of their patients, and improving both patients’ and professionals’ satisfaction. In the period 2005-2006, 12% of the 763 employed GPs in the ASLMB were involved in the experiment, while this percentage increased to 15-20% in 2007-2008. Design and Methods. Twenty-four GPs were purposively sampled, randomly divided into two groups and asked to participate in focus groups (FGs) held in 2008, aimed at evaluating their perception of the experiment. The FGs were audio-recorded, dialogues were typed out and undergone to a thematic analysis, according to the Interpretative Phenomenological Approach. Results. Four major themes emerged: i) clinical pathways can result in GPs working in a more efficient and effective fashion; ii) they can assure higher levels of both patient and professional satisfaction, since they sustain a caring approach and strengthen the GPs’ role; iii) nevertheless, clinical pathways increase the bureaucratic workload and problems can arise in relationships among GPs and the LHA; iv) the implementation of clinical pathways can be improved, especially by reducing bureaucracy and by assuring their continuity. Conclusions. Managerial aspects should be considered with care in order to experimentally introduce clinical pathways in general practice, and continuity of the experimentation should be guaranteed to improve GPs’ adherence and commitment.

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Author Biographies

Lucia Zannini, University of Milano
Department of Biomedical Sciences for Health
Cesarina Cattaneo, University of Milano
Department of Biomedical Sciences for Health
Paolo Peduzzi, University of Milano
Department of Biomedical Sciences for Health
Silvia Lopiccoli, ASL Monza Brianza
Health Management Unit
Published
2012-07-31
Section
Original Articles
Keywords:
clinical governance, clinical pathways, general practice, focus group, continuing medical education
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How to Cite
Zannini, L., Cattaneo, C., Peduzzi, P., Lopiccoli, S., & Auxilia, F. (2012). Experimenting clinical pathways in general practice: a focus group investigation with Italian general practitioners. Journal of Public Health Research, 1(2), e30. https://doi.org/10.4081/jphr.2012.e30