Australian General Practitioners’ perspectives, experiences and use of non-drug interventions in primary care: a qualitative study

TL;DR

This study explores how Australian general practitioners use non-drug interventions in primary care and the factors influencing their decisions.

Contribution

The study provides new insights into GPs' perspectives on non-drug interventions, which have been underexplored in prior research.

Findings

GPs' knowledge of non-drug interventions is limited by gaps in medical education and training.

Patient characteristics and expectations significantly influence GPs' decisions to prescribe non-drug interventions.

Time constraints and billing policies in primary care affect how GPs use non-drug interventions.

Abstract

Non-drug interventions (NDIs) are underused in primary care, despite established effectiveness, safety, cost–benefit and guidelines. Existing research exploring barriers and enablers to NDI use primarily focuses on patients’ perspectives, leaving general practitioners’ (GPs’) perspectives underexplored, despite their critical role in NDI delivery. The objective of this study is to explore Australian GPs’ experiences and perspectives on the use of NDIs in primary care.

An interview study informed by realist methodology. Transcripts were abductively analysed, with a sample analysed by two researchers, using the Theoretical Domains Framework, which allows identification of individual and contextual factors that influence behaviour, and discussed in team meetings to develop themes.

Interviews took place either in person or online via Zoom, were audio-recorded and transcribed verbatim.

A convenience sample of GPs working in Australian primary care.

14 GPs were interviewed for an average of 59 min. Four themes were developed representing the latent mechanisms underlying GPs’ prescription and use of NDIs. (1) Obtaining and sharing knowledge: GPs’ learning about NDIs is limited through medical school and continuing education, highlighting gaps in tertiary and specialty training. Sharing knowledge occurs bidirectionally. GPs share their learnt knowledge about NDIs with patients, who in turn share their lived experience knowledge. (2) Considering the patient: patient characteristics, circumstances and actual or perceived expectations influenced GPs’ NDI prescription. Influences included financial status, therapeutic relationship, patient motivation, presenting condition and medication expectation. (3) Influence of primary care environment: time constraints, billing and policies influenced when and how GPs used and prescribed NDIs. Interprofessional collaboration and distributing patient resources were strategies used by GPs to overcome barriers. (4) NDIs part of GPs’ role and identity: NDIs were prescribed as first-line treatments, preventative strategies or as an adjuvant to medication for both acute or chronic conditions, highlighting NDIs as core to GPs’ role and care.

This study reveals the interplay of factors and mechanisms influencing Australian GPs’ use of NDIs, including systemic, educational and interpersonal dynamics. To optimise the integration of NDIs in primary care, prioritised training, clearer guidance and better access to evidence-based resources are required.

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