RESUMEN
Generational change is believed to be transforming the educational and employment preferences of medical trainees. In this article, we examine generational tensions in interviews with policy leaders and clinicians on workforce issues within one subset of the Australian medical profession: general practitioners who provide care to people with HIV in community settings. Integrating the accounts of policy leaders (n = 24) and clinicians representing the 'first generation' (n = 21) and 'next generation' (n = 23) of clinicians to do this work, shared and divergent perspectives on the role of generational change in shaping professional engagement were revealed. While those engaged in the early response to HIV believed younger clinicians to be less interested in the scientific and political dimensions of HIV care and more concerned about financial security and life balance, the next generation both countered and integrated these beliefs into new ways of conceptualising the value and appeal of this field of medicine. Critical appraisal of the assumptions that underpin generational discourse is essential in appreciating the changing views of providers over time, particularly in fields of medicine which have featured significant historical turning points.
Asunto(s)
Actitud del Personal de Salud , Médicos Generales/psicología , Infecciones por VIH/terapia , Política de Salud , Síndrome de Inmunodeficiencia Adquirida/terapia , Adulto , Factores de Edad , Anciano , Australia , Selección de Profesión , Servicios de Salud Comunitaria/organización & administración , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana EdadRESUMEN
As the management of HIV changes and demand for HIV health services in primary care settings increases, new approaches to engaging the general practice workforce with HIV medicine are required. This paper reports on qualitative research conducted with 47 clinicians who provide HIV care in general practice settings around Australia, including accredited HIV s100 prescribers as well as other GPs and general practice nurses. Balanced numbers of men and women took part; less than one-quarter were based outside of urban metropolitan settings. The most significant workforce challenges that participants said they faced in providing HIV care in general practice were keeping up with knowledge, navigating low caseload and regional issues, balancing quality care with cost factors, and addressing the persistent social stigma associated with HIV. Strategic responses developed by participants to address these challenges included thinking more creatively about business and caseload planning, pursuing opportunities to share care with specialist clinicians, and challenging prejudiced attitudes amongst patients and colleagues. Understanding and supporting the needs of the general practice workforce in both high and low HIV caseload settings will be essential in ensuring Australia has the capacity to respond to emerging priorities in HIV prevention and care.
Asunto(s)
Medicina General , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Adulto , Anciano , Australia , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación CualitativaRESUMEN
Research has shown that social representations of HIV can constitute barriers to health workers' willingness to provide HIV care. Considering a growing shortage in the HIV primary workforce in Western countries, we examine how HIV is perceived today by doctors involved in its care. In 1989 Sontag predicted that once the virus became better understood and treatable, the dehumanizing meanings that defined the early epidemic would vanish and HIV would turn into an ordinary illness. However, research shows that HIV still carries stigma, including in the health care sector. Drawing on qualitative interviews, we found that HIV doctors in Australia perceived HIV as a far-from-ordinary chronic illness because of its extraordinary history and its capacity to extend in multiple clinical and social directions. These rarely explored perspectives can contribute to the social reframing of HIV and to strategies to build a dedicated HIV workforce in Australia and elsewhere.
Asunto(s)
Actitud del Personal de Salud , Médicos Generales/psicología , Infecciones por VIH/psicología , Percepción , Adulto , Australia , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Estigma SocialRESUMEN
BACKGROUND: The science of HIV prevention and treatment is evolving rapidly, resulting in renewed calls to increase rates of HIV testing and, in particular, facilitate the timely and possibly earlier initiation of treatment, as this has the potential to dramatically reduce new infections. Little is known about how to engage non HIV specialist Australian general practitioners (GPs) with these new priorities. METHODS: Content related to the engagement of non HIV specialist GPs in the HIV response was identified within the transcripts of in-depth interviews with policy key informants (n=24) and general practice clinicians (n=47) engaged with HIV medicine. A qualitative analysis of the semantic meaning of this content identified three categories of 'issues' described by participants. RESULTS: Educational issues referred to a lack of attention to HIV in medical curricula, a perception that HIV care is only provided by HIV-specialist GPs, a need to make HIV testing more 'routine' in GP education and a need to strengthen GP awareness of referral options. Organisational issues encompassed time pressures in general practice, and a need for general practice nurses and for rapid testing to become available, as well as formalised peer mentoring and comanagement opportunities. Societal issues included the changing dynamics of HIV transmission and a need to reconnect GPs with the Australian HIV response. CONCLUSIONS: To successfully engage non HIV specialist GPs in the promotion of regular HIV testing and timely initiation of treatment, challenging issues affecting their capacity and willingness must be urgently addressed.
Asunto(s)
Diagnóstico Precoz , Médicos Generales/educación , Infecciones por VIH/prevención & control , Seropositividad para VIH/diagnóstico , Antirretrovirales/uso terapéutico , Australia , Infecciones por VIH/terapia , Promoción de la Salud , Humanos , Investigación Cualitativa , Tiempo de TratamientoRESUMEN
BACKGROUND: HIV has become a chronic manageable infection in the developed world, and early and lifelong treatment has the potential to significantly reduce transmission rates in the community. A skilled and motivated HIV medical workforce will be required to achieve these health management and prevention outcomes, but concerns have been noted in a number of settings about the challenges of recruiting a new generation of clinicians to HIV medicine. METHODS: As part of a larger qualitative study of the HIV general practice workforce in Australia, in-depth interviews were conducted with 31 general practitioners accredited to prescribe HIV medications in community settings. A thematic analysis was conducted of the de-identified transcripts, and this paper describes and interprets accounts of the rewards of pursuing and sustaining an engagement with HIV medicine in general practice settings. RESULTS: The rewards of initially becoming involved in providing care to people living with HIV were described as interest and inspiration, community calling and right place, right time. The rewards which then supported and sustained that engagement over time were described as challenge and change, making a difference and enhanced professional identity. Participants viewed the role of primary care doctor with special expertise in HIV as occupying an ideal interface between the 'coalface' and the 'cutting edge', and offering a unique opportunity for general practitioners to feel intimately connected to both community needs and scientific change. CONCLUSIONS: Approaches to recruiting and retaining the HIV medical workforce should build upon the intellectual and social rewards of this work, as well as the sense of professional belonging and connection which is imbued between both doctors and patients and across the global and national networks of HIV clinicians. Insights regarding the rewards of engaging with HIV medicine may also be useful in enhancing the prospect of general practice as a career, and strengthening retention and job satisfaction among the existing general practice workforce.
Asunto(s)
Médicos Generales/psicología , Infecciones por VIH/terapia , Motivación , Rol del Médico , Recompensa , Especialización , Adulto , Australia , Selección de Profesión , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVES: HIV care is provided in a range of settings in Australia, but advances in HIV treatment and demographic and geographic changes in the affected population and general practitioner (GP) workforce are testing the sustainability of the special role for GPs. This paper explores how a group of 'key informants' described the role of the GP in the Australian approach to HIV care, and conceptualised the challenges currently inspiring debate around future models of care. METHODS: A thematic analysis was conducted of semistructured interviews carried out in 2010 with 24 professionals holding senior roles in government, non-government and professional organisations that influence Australian HIV care policy. RESULTS: The strengths of the role of the GP were described as their community setting, collaborative partnership with other medical and health professions, and focus on patient needs. A number of associated challenges were also identified including the different needs of GPs with high and low HIV caseloads, the changing expectations of professional roles in general practice, and barriers to service accessibility for people living with HIV. CONCLUSIONS: While there are many advantages to delivering HIV services in primary care, GPs need flexible models of training and accreditation, support in strengthening relationships with other health and medical professionals, and assistance in achieving service accessibility. Consideration of how to support the GP workforce so that care can be made available in the broadest range of geographical and service settings is also critical if systems of HIV care delivery are to be realistic and cost-effective and meet consumer needs.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Atención a la Salud/organización & administración , Médicos Generales , Infecciones por VIH/diagnóstico , Infecciones por VIH/terapia , Australia , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/métodos , Atención a la Salud/economía , Atención a la Salud/métodos , Femenino , Política de Salud , Humanos , Entrevistas como Asunto , MasculinoRESUMEN
The population of people living with HIV in Australia is increasing, requiring an expert primary care workforce to provide HIV clinical care into the future. Yet the numbers of family doctors or general practitioners (GPs) training as community-based HIV medication prescribers may be insufficient to replace those retiring, reducing hours or changing roles. We conducted semi-structured interviews between February and April, 2010, with 24 key informants holding senior roles in organisations that shape HIV-care policy to explore their perceptions of contemporary issues facing the HIV general practice workforce in Australia. Informed by interpretive description, our analysis explores how these key informants characterised GPs as being 'moved' by the clinical, professional and political dimensions of the role of the HIV general practice doctor. Each of these dimensions was represented as essential to the engagement of GPs in HIV as an area of special interest, although the political dimensions were often described as the most distinctive compared to other areas of general practice medicine. Our analysis explores how each of these dimensions contributes to shaping the contemporary culture of HIV medicine and suggests that such an approach could be useful for understanding how health professionals become engaged in other under-served areas of medical work.