Brown Ken, Stainer Karen, Stewart Jane, Clacy Rose, Parker Sharron
General Practitioner, Family Medical Centre, Nottingham, UK.
Qual Prim Care. 2008;16(6):409-17.
The Department of Health in the UK has suggested that older people with complex health problems may benefit from a case-management approach to meet their needs. The NHS has since invested heavily in community matrons as one method of tackling managed care. Matrons are highly trained nurses, able to diagnose, prescribe and manage patients with long-term conditions within primary care. Early evidence suggests that the matron approach does not achieve the government targets of reducing unplanned hospital admissions.
To explore the experiences and attitudes of older people who have a community matron so that we may gain an understanding of the successes and failures of this form of case management.
Qualitative study using one-to-one interviews with patients and carers. Setting Nottingham and surrounding rural areas during 2006-2007.
A purposive sample of patients recruited from community matron caseloads. In-depth semi-structured interviews were audiotaped and transcribed. Analysis for emergent themes used a template approach and was validated by discussion with lay advisors and community matrons and by separate analysis of a sample of interviews by an independent researcher.
Twenty-four participants were recruited. They often valued their matron as a personal friend as well as a professional. Many suggested that matrons improved their global health, reduced the workload of general practitioners, kept them out of residential care, reduced the need for social and psychological care, and supported their carers. Some were unclear why they had been selected for the matron service and knew of others they felt would benefit more than them.
Matrons seem to be generally highly valued on a professional and personal level, almost filling the role of family doctor vacated by changing practices in modern primary care. Participants suggested several reasons why matrons could be economically justified, which need further investigation. The methods of case selection for these services also need to be questioned.
英国卫生部建议，患有复杂健康问题的老年人可能会从个案管理方法中受益，以满足他们的需求。此后，英国国家医疗服务体系（NHS）大力投资社区护士长，将其作为解决管理式医疗的一种方式。护士长是经过高度培训的护士，能够在初级医疗保健中诊断、开处方并管理患有长期疾病的患者。早期证据表明，护士长模式并未实现政府减少非计划住院人数的目标。
探讨有社区护士长的老年人的经历和态度，以便我们了解这种个案管理形式的成败。
采用对患者和护理人员进行一对一访谈的定性研究。于2006 - 2007年在诺丁汉及周边农村地区开展。
从社区护士长的病例清单中选取有目的的患者样本。深入的半结构化访谈进行了录音和转录。对浮现主题的分析采用模板方法，并通过与外行顾问和社区护士长讨论以及由独立研究人员对部分访谈样本进行单独分析来验证。
招募了24名参与者。他们常常将护士长视为私人朋友和专业人士。许多人表示，护士长改善了他们的整体健康状况，减轻了全科医生的工作量，使他们无需入住养老院，减少了对社会和心理护理的需求，并为他们的护理人员提供了支持。一些人不清楚自己为何被选入护士长服务，并且知道还有其他人他们觉得会比自己受益更多。
护士长在专业和个人层面似乎普遍受到高度重视，几乎填补了现代初级医疗保健中因实践变化而空缺的家庭医生角色。参与者提出了护士长在经济上合理的几个原因，这需要进一步调查。这些服务的病例选择方法也需要受到质疑。
