JENS LUNDEGÅRD: Transformation of General Practice

Project description

Background

The past decades there has been a continuous progress towards increasing management control of primary care. Political, economic and bureaucratic management as well as the Evidence Based Medicine movement with its emphasis of clinical guidelines have impacted this development.

How an increased management control of primary care affects the practice of family medicine in Sweden has not been thoroughly studied. International studies point towards problems with combining a holistic approach in primary care with clinical guidelines, consequences for the doctor-patient relationship and difficulties with relying on clinical guidelines in a complex reality.

Aim

The overall aim of this research project is to explore how an increased management control in primary care impacts the practice of family medicine. To fulfill the aim the following research questions have been formulated:

• How is the practice of primary care physicians affected by an increased management control regarding the doctor-patient relation, the professional autonomy, the balance between reflexive understanding and algorithm-based knowledge, and the working environment?
• What are the patients’ perceptions of the care provided and the sense of participation in decision-making during a consultation where the health care has a clearly predefined agenda?
• From these experiences, what ethical problems may occur due to increased management control of physicians, and can a continuation of this progress be ethically justified?  

Methods

The first two studies in this project will be based on semi-structured interviews and use qualitative methodology to explore how specialists in family medicine and patients experience the effects of increased management control. The third study is planned as a mixed-methods study in which patient records are examined to look for traces and consequences of increased management control. The last study will be an ethical analysis using reflective equilibrium as method to fulfill the aim of the study.

Relevance

In light of the big reform of primary care the implementation of the national system for knowledge-driven management is; its effects on the practice of family medicine and for the patients need to be more studied. It is also of importance that structural changes of health care be subject to ethical analysis to identify possible ethical conflicts and to come with suggestions on how to handle such conflicts. Hence this project has an important role.