Expert informant: interview guide
[Sample]
Preamble:
Discuss the nature of the Inquiry, why they have been chosen to participate, what the interview is about, and how long it will take. Ask permission to record interview, stressing all data will be stored securely and only used for the purposes of the Inquiry. Ask the interview for any questions or points of clarification
Introduction – role, experience, expertise
To provide us with an understanding of your experience and expertise, I would like to start by asking you to say a bit about yourself – your role (current job), your experience and involvement with regard to the issue of quality of care for people with [insert long-term condition here] in general practice.
Condition-specific questions
I want to start by asking about high-quality care for people with [insert condition] generally, and then move on to focus specifically on the role of general practice within that.
1. In an ideal world, what would high-quality care for people with [depression] look like in general terms (in other words, regardless of location of care)?
• In an ideal world what would best quality care look like or contain for a
patient with [condition]? [prompt about care pathways]
• Is there much evidence or guidance to tell us what best quality of patient care should look like?
• How useful are models of care for managing these patients? [prompt – for example, collaborative care, care management]. What components of these are most important?
2. What do you think the role of general practice should be, in the delivery of such high-quality care for people with [insert condition]?
• What things lie within the core role of general practice, and what enhanced roles could there be – for example, for GPs with a special
interest? Enhanced services by a practice-based team?
[Prompt: Discuss GP role in advice giving, diagnosis, referral to services treatment, ongoing monitoring, supported self care]. • What role does self-care play?
[Prompt: Self care is advice and support to enable people to live healthy and at home, ongoing relationship between patient and general practice].
• What role should other staff within the practice play – for example, staff nurses, practice managers, receptionists?
3. You’ve described what management of [insert condition] should look like in general practice – how close are we to that, in reality?
• What is your impression generally of the quality of care provided by general practices?
• What is the extent of variations in quality? [Ask about variations in terms of area, deprivation, gender, ethnicity, practice size/level etc.] • What accounts for the variations? What impedes best quality care in
general practice for people who suffer with [insert condition]? • What are the key areas in which general practice as a whole could
improve the quality of care it provides to patients with [insert
condition]?
4. What quality improvement tools or approaches could be used to improve the quality of care for [depression] in general practice? • If you were attempting to measure the quality of care provided to
people with [insert condition] by general practice, what would be the
key measures of quality you might use?
• Are there any current measures that you are aware of that are currently being used to measure quality? What are these? Are these measures suitable?
• Is using measures and metrics a useful approach to quality improvement? What other approaches could be used? People with multiple long-term conditions
I’d like to talk now about people with more than one long-term condition, and how their needs should be managed.
5. Would high-quality care for patients with multiple LTCs be different than for people with a single condition?
• Are there any particular models of care that are appropriate for people with multiple LTCs (eg ‘guided care’)?
6. How about the role of general practice – would that look different for people with multiple LTCs compared to those only with [insert condition]? • How close are we to that vision of best practice in reality? Any areas for
improvement? Extent of variations in quality, and reasons for this. • What areas would you focus on to make the biggest difference in care
quality?
• Are current measures of quality of care any different for people with
Population management
I want to ask about taking proactive approaches to the management of people with LTCs. Proactive population management – identifying patients who might be at increased risk of developing long-term conditions, or identifying those with an existing diagnosis whose risk of deterioration is increasing.
7. [ONLY ASK IF THE INTERVIEWEE IS A PRACTISING GP]. Do you undertake any proactive population management of your registered patients? • Do you run any screening/preventative/pre-emptive programme to
identify those most at risk of deterioration or unplanned admission to hospital for example?
• How do you make sure you target this proactive care at the right
patients? Is this an accurate method?
• What sort of interventions do you offer to patients identified as being at risk? Do you offer different sorts of care to different patients, depending on the level of risk?
8. What are the pros and cons of GPs taking proactive approaches to managing all their registered patients for LTCs (not just those already identified with a LTC)?
• How important do you think this proactive or pre-emptive work is in management of LTCs? Is it a key part of the role of the GP? If not, who should be offering it?
Implications for general practice
Finally, I’d like to ask about the implications of what we’ve been talking about for the general model of general practice used in this country.
9. Do you think the model of general practice needs to adapt in a broader or more fundamental sense in order to meet the needs of patients with [insert condition]?
• If so, how should it adapt?
10. Do you know of any examples of best practice that would be worth investigating as a case example? [single LTC or multiple LTC] • Prompt for details and contacts.
Thank you for participating in this interview about the quality of long-term conditions management in general practice.
Would you be interested in attending an expert seminar in [give date if possible] to discuss the quality of long-term conditions management in general practice?
Appendix 3 Number and types of expert
informants interviewed
Type of informant B
Arthritis Dementia Diabetes Depression Total
GP or GP with a special interest 3 3 2 5 13
LTC nurse or other primary care professional 1 1 1 1 4
PCT commissioner 1 - 1 0 2
Policy-maker 1 1 1 1 4
Academic 3 2 2 2 9
Representative of patient group or society 2 4 2 1 9
London W1G OAN Tel 020 7307 2400