Bayliss Elizabeth A, Edwards Allison E, Steiner John F, Main Deborah S
Kaiser Permanente Institute for Health Research, Denver, CO 80237-8066, USA.
Fam Pract. 2008 Aug;25(4):287-93. doi: 10.1093/fampra/cmn040. Epub 2008 Jul 14.
Most recommended care for chronic diseases is based on the research of single conditions. There is limited information on 'best' processes of care for persons with multiple morbidities. Our objective was to explore processes of care desired by elderly patients who have multimorbidities that may present competing demands for patients and providers.
Qualitative investigation using one-on-one interviews of 26 community-dwelling HMO members aged 65-84 (50% male) who had, at a minimum, the combined conditions of diabetes, depression and osteoarthritis. Participants were chosen from a stratified random sample to have a range of 4-16 chronic medical conditions.
Participants' desired processes of care included: the need for convenient access to providers (telephone, internet or in person), clear communication of individualized care plans, support from a single coordinator of care who could help prioritize their competing demands and continuity of relationships. They also desired providers who would listen to and acknowledge their needs, appreciate that these' needs were unique and fluctuating and have a caring attitude.
These respondents describe an ideal process of care that is patient centered and individualized and that supports their unique constellations of problems, shifting priorities and multidimensional decision making. Individual and ongoing care coordination managed by a primary contact person may meet some of these needs. Achieving these goals will require developing efficient methods of assessing patient care needs and flexible care management support systems that can respond to patients' needs for different levels of support at different times.
大多数推荐的慢性病护理是基于单一疾病的研究。关于患有多种疾病的患者的“最佳”护理流程的信息有限。我们的目标是探索患有多种疾病的老年患者所期望的护理流程，这些疾病可能给患者和医护人员带来相互冲突的需求。
采用一对一访谈的定性调查方法，对26名年龄在65 - 84岁的社区居住的健康维护组织（HMO）成员进行访谈，这些成员至少患有糖尿病、抑郁症和骨关节炎这几种合并病症。参与者从分层随机样本中选取，患有4 - 16种慢性疾病。
参与者期望的护理流程包括：需要方便地联系医护人员（通过电话、互联网或亲自就诊），清晰地传达个性化护理计划，由单一护理协调员提供支持，该协调员能够帮助他们对相互冲突的需求进行优先级排序，并保持关系的连续性。他们还希望医护人员能够倾听并认可他们的需求，认识到这些需求是独特且多变的，并具有关怀的态度。
这些受访者描述了一个以患者为中心、个性化的理想护理流程，该流程支持他们独特的问题组合、不断变化的优先级和多维度决策。由主要联系人进行的个性化和持续的护理协调可能满足其中一些需求。实现这些目标将需要开发有效的方法来评估患者的护理需求，以及灵活的护理管理支持系统，该系统能够在不同时间响应患者对不同支持水平的需求。
