Charles-Jones Huw, May Carl, Latimer Joanna, Roland Martin
School of Primary Care, University of Manchester, UK.
J Health Serv Res Policy. 2003 Jul;8(3):154-9. doi: 10.1258/135581903322029502.
To examine the perceptions that those working in primary care have about the purpose and impact that telephone triage by nurses may have on their clinical roles and identities.
Twenty-six semi-structured interviews were carried out with general practitioners (GPs), practice nurses and practice managers from a purposive sample of nine practices in one health district in the North West of England. Analysis drew on the techniques of constant comparison and discourse analysis.
Four themes emerged from the data: justifying triage - the respondents justify the introduction of telephone triage by emphasising the managerial benefits of controlling access and by suggesting the benefits this may bring to the patient-clinician relationship; categorising patients - patients are categorised and allocated on the basis of their biomedical diagnoses to the nurses or GPs in the practice; changing roles and identities - the hierarchy of patients and conditions created by allocating patients in this way strengthens and extends the professional hierarchy within a practice; and achieving a balance between conflicting aims - there is tension between the managerial need to triage patients according to their biomedical diagnosis and the aspirations that health care professionals have to personal and patient-centred care.
Telephone triage by nurses may be effective at managing patient access to GPs but the need to categorise patients according to biomedical and managerial criteria needs to be balanced against the professional roles and identities that those working in general practice aspire to.
探讨基层医疗工作人员对于护士电话分诊的目的及其对自身临床角色和身份的影响的看法。
对来自英格兰西北部一个健康区9家诊所的全科医生（GP）、执业护士和诊所经理进行了26次半结构化访谈，样本选取具有目的性。分析采用持续比较法和话语分析法。
数据中出现了四个主题：为分诊辩护——受访者通过强调控制就诊机会的管理益处以及表明这可能给医患关系带来的好处来为电话分诊的引入进行辩护；对患者进行分类——根据患者的生物医学诊断将患者分类并分配给诊所的护士或全科医生；角色和身份的变化——通过这种方式分配患者所形成的患者和病情等级制度强化并扩展了诊所内的专业等级制度；在相互冲突的目标之间取得平衡——根据患者的生物医学诊断进行分诊的管理需求与医疗保健专业人员对个性化和以患者为中心的护理的期望之间存在紧张关系。
护士电话分诊在管理患者看全科医生的机会方面可能有效，但根据生物医学和管理标准对患者进行分类的需求需要与全科医疗工作人员所期望的专业角色和身份相平衡。
