晚期慢性阻塞性肺疾病（COPD）的就医情况：影响与全科医疗服务机构接触的因素
Access to care in advanced COPD: factors that influence contact with general practice services.
作者信息
Shipman Cathy, White Suzanne, Gysels Marjolein, White Patrick
机构信息
Department of General Practice and Primary Care, King's College London, London, UK.
出版信息
Prim Care Respir J. 2009 Dec;18(4):273-8. doi: 10.4104/pcrj.2009.00013.
AIMS
To explore factors that influence the use of general practice services by people with advanced COPD.
METHOD
An exploratory qualitative study using in-depth interviews at home with 16 patients who had advanced COPD, recruited through general practices in south-east London. The Framework Approach was used to analyse interview transcripts.
RESULTS
Interviewees had a mean age of 70 and a mean FEV1 of 24% predicted. All reported severe breathlessness. They contacted general practices for routine, urgent and emergency care. Contact was influenced by perceptions of ease of access, quality of relationship with their general practitioner (GP), and perceived disease severity and threat. Some patients wanted to avoid bothering the doctor or found travelling to the surgery too difficult.
CONCLUSION
Factors other than need influenced patterns of health service use. Expectations of difficulty in access, and poor relationships with their GP, may have delayed help-seeking in severe acute exacerbations.
目的
探讨影响晚期慢性阻塞性肺疾病（COPD）患者使用全科医疗服务的因素。
方法
采用探索性定性研究，通过伦敦东南部的全科诊所招募了16名晚期COPD患者，并对其进行了家庭深入访谈。采用框架分析法对访谈记录进行分析。
结果
受访者的平均年龄为70岁，预计第一秒用力呼气容积（FEV1）平均为24%。所有受访者均报告有严重的呼吸困难。他们因常规、紧急和急诊护理而联系全科诊所。联系受到对就医便利性的认知、与全科医生（GP）关系的质量以及感知到的疾病严重程度和威胁的影响。一些患者想避免打扰医生，或者觉得前往诊所就诊过于困难。
结论
除需求外，其他因素也影响了医疗服务的使用模式。对就医困难的预期以及与全科医生关系不佳，可能导致在严重急性加重期延迟寻求帮助。
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