Cowie Luke, Morgan Myfanwy, White Patrick, Gulliford Martin
Department of Public Health Sciences, London, UK.
J Health Serv Res Policy. 2009 Apr;14(2):82-7. doi: 10.1258/jhsrp.2009.008111.
To examine patients' experiences of continuity of care in the context of different long-term conditions and models of care, and to explore implications for the future organization care of long-term conditions.
Qualitative semi-structured interviews were carried out with 33 patients recruited from seven general practices in South London. Patients were selected who had one or more of the following long-term conditions: arthritis, coronary heart disease, stroke, hypercholesterolaemia, hypertension, diabetes mellitus or chronic obstructive pulmonary disease.
Multiple morbidity was frequent and experiences of continuity were framed within patients' wider experiences of health care rather than the context of a particular diagnosis. Positive experiences of relational continuity were strongly associated with long-term GP-led or specialist-led care. Management continuity was experienced in the context of shared care in terms of transitions between professionals or organizations. Access and flexibility issues were identified as important barriers or facilitators of continuity.
Across a range of long-term conditions, patients' experiences of health care can be understood in terms of nuanced understandings of relational and management continuity. Continuity experiences, meanings and expectations, as well as barriers and facilitators, are influenced by the model of care rather than type of condition.
考察患者在不同长期病症及护理模式背景下的连续性护理体验，并探讨其对未来长期病症护理组织的影响。
对从伦敦南部七个全科诊所招募的33名患者进行了定性半结构化访谈。入选患者患有以下一种或多种长期病症：关节炎、冠心病、中风、高胆固醇血症、高血压、糖尿病或慢性阻塞性肺疾病。
多种疾病并存的情况很常见，连续性体验是在患者更广泛的医疗保健体验中形成的，而非特定诊断背景下。关系连续性的积极体验与长期由全科医生主导或专科医生主导的护理密切相关。在专业人员或组织之间的过渡方面，共享护理背景下体验到了管理连续性。获得护理的机会和灵活性问题被确定为连续性的重要障碍或促进因素。
在一系列长期病症中，患者的医疗保健体验可以通过对关系连续性和管理连续性的细致理解来解读。连续性体验、意义和期望，以及障碍和促进因素，受护理模式而非病症类型的影响。
