共享护理：关于全科医生和医院医生对专科药物处方看法的定性研究
Shared care: a qualitative study of GPs' and hospital doctors' views on prescribing specialist medicines.
作者信息
Horne R, Mailey E, Frost S, Lea R
机构信息
Centre for Health Care Research, University of Brighton, 1 Great Wilkins, Falmer Campus, Brighton, BN1 9PH.
出版信息
Br J Gen Pract. 2001 Mar;51(464):187-93.
BACKGROUND
Shared care schemes have mainly centred on chronic diseases, such as asthma and diabetes. However, with increasing government emphasis on primary and secondary care integration and the effects of budget restraints, general practitioners (GPs) have been asked to take on the prescribing of specialist medicines.
AIM
To elicit the views and experiences of GPs and hospital doctors about existing arrangements for shared care applied to the prescribing of specialist medicines. To identify a set of quality indicators for prescribing specialist medicines at the interface between primary and secondary care.
DESIGN OF STUDY
A qualitative study based on semi-structured interviews.
SETTING
Forty-eight GPs and 13 hospital doctors in the former South Thames region.
METHOD
The interviews focused on how far experiences with shared care compare with the arrangements currently in place for prescribing specialist medicines and identified the barriers to facilitators of effective shared care.
RESULTS
A number of key themes were identified and these formed the basis for eight quality indicators relating to the prescribing of specialist medicines where treatment is shared between primary and secondary care. The themes centred around issues of clinical responsibility, 'cost-shifting', availability of medicines, GP satisfaction, and the nature of the prescribing relationship.
CONCLUSION
Overall, GPs appeared dissatisfied with arrangements for prescribing specialist medicines, while hospital doctors were generally satisfied. The quality indicators will form the basis of a more extensive quantitative survey of GPs' perceptions of the arrangements for prescribing specialist medicines.
背景
共享护理计划主要集中于慢性病，如哮喘和糖尿病。然而，随着政府日益强调初级和二级护理整合以及预算限制的影响，全科医生（GPs）被要求承担专科药物的处方工作。
目的
了解全科医生和医院医生对应用于专科药物处方的现有共享护理安排的看法和经验。确定一套在初级和二级护理交界处开具专科药物的质量指标。
研究设计
基于半结构化访谈的定性研究。
研究地点
前南泰晤士地区的48名全科医生和13名医院医生。
方法
访谈聚焦于共享护理的经验与目前专科药物处方安排的契合程度，并确定有效共享护理的促进因素和障碍。
结果
确定了一些关键主题，这些主题构成了与初级和二级护理共享治疗的专科药物处方相关的八项质量指标的基础。这些主题围绕临床责任、“成本转移”、药物可及性、全科医生满意度以及处方关系的性质等问题。
结论
总体而言，全科医生似乎对专科药物处方安排不满意，而医院医生总体上感到满意。这些质量指标将构成对全科医生对专科药物处方安排看法的更广泛定量调查的基础。
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