Table 2 Theoretical domains and sample quotes related to pathways and access to follow-up care
TDF domain | Theme (Barrier [B], Enabler [E], Mixed [M]) | Quote |
|---|---|---|
Lack of standardised follow-up care pathway | ||
Environmental context and resources | Variability in follow-up pathways (M) | “So we found that with some TIA clinics they offer a follow up appointment around six to eight weeks, sometimes it’s consultant led and sometimes it’s nurse led so you can imagine that those appointments would be very different depending on who they speak to whereas other TIA clinics don’t have that option at all so there’s a very disjointed follow up pathway which people are getting...” [H8, GP, 17 Years of experience] |
Restricted access to early supported discharge (B) | “So, for the TIAs obviously we don’t do that [Early Supported Discharge] there’s no follow up.” [H17, Stroke consultant, 8 Years of experience] | |
Intentions | Variability in consultants use of nurse-led follow-up (M) | “We do have a, for follow-up we do have a nurse lead follow-up clinic. Which I have access to, but I don’t use a lot. And again, there’s some variation in practice amongst the five stroke physicians about how much they use that clinic.” [H20, Neurologist, 22 Years of experience] |
Variability in GPs having an active vs passive approach to follow-up (M) | “…personally I quite like to see patients particularly when patients have been started on a whole bunch of new tablets… So, I like to get them to come and see me.” [H11, GP, 18 Years of experience] “…it wouldn’t be feasible for every specialist letter we get for strokes and everything else to contact the patient to sort of go through the [medication], we wouldn’t do anything else really. So we add the medication to the repeat prescription” [H13, GP, 13 Years of experience] | |
Interface between healthcare settings | ||
Environmental context and resources | Restricted communication between healthcare settings (B) | “So, I think for me part of the problem is sometimes the access to the specialist. And yeah, we can fax over letters and we can make phone calls and we can try and bleep people and we can email and all this sort of thing, but you know my experience generally is that we don’t get a lot of information back.” [H11, GP, 18 Years of experience] |
Variability in content and speed of discharge letters (M) | “Communication is quite good. It’s quick. The turnaround on letters is quick…” [H3, AHP, 23 Years of experience] “We’re still relying on old paper letters, which, you know, we probably shouldn’t be anymore and communication is very slow, so it takes us six weeks often to get a clinic letter and if something’s urgent then we can’t afford to wait that long.” [H13, GP, 13 Years of experience] | |
Intentions | Variability in how GPs engage with discharge letters (M) | “And we tend to just wait for the [discharge] letter, act on it… It’s very much been directed by the secondary care rather than doing a massive amount off our own backs.” [H12, GP, 7 Years of experience] “And certainly the discharge letters are quite ‘protocolised’ again in that… And there’s things that they will put on there that you just think ‘well, there’s no need for that to be on there’ in terms of giving me advice here…” [H11, GP, 18 Years of experience] |
Social Influences | GPs have difficulty accessing imaging results and specialist stroke advice (B) | “But obviously it’s a bit hard to give them [patients] absolute reassurance because in terms of the scan reports or the results on the investigations, may not be entirely with us…” [H9, GP, 6 Years of experience] |