Pinnock Hilary, Huby Guro, Tierney Alison, Hamilton Sonya, Powell Alison, Kielmann Tara, Sheikh Aziz
Allergy & Respiratory Research Group, Centre for Population Health Sciences: GP Section, University of Edinburgh, 20 West Richmond St, Edinburgh EH8 9DX, UK.
J R Soc Med. 2009 Sep;102(9):378-90. doi: 10.1258/jrsm.2009.080356.
Using frameworks, such as the long-term conditions pyramid of healthcare, primary care organizations (PCOs) in England and Wales are exploring ways of developing services for people with long-term respiratory disease. We aimed to explore the current and planned respiratory services and the roles of people responsible for change.
A purposive sample of 30 PCOs in England and Wales.
Semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services. Recorded interviews were transcribed and coded, and themes identified. The association of the composition of the team driving change with the breadth of services provided was explored using a matrix.
All but two of the PCOs described clinical services developed to address the needs of people with respiratory conditions, usually with a focus on preventing admissions for chronic obstructive pulmonary disease (COPD). Although the majority identified the need to develop a strategic approach to service development and to meet educational needs of primary care professionals, relatively few described clearly developed plans for addressing these issues. Involvement of clinicians from both primary and secondary care was associated with a broad multifaceted approach to service development. Teamwork was often challenging, but could prove rewarding for participants and could result in a fruitful alignment of objectives. The imminent merger of PCOs and overriding financial constraints resulted in a 'fluid' context which challenged successful implementation of plans.
While the majority of PCOs are developing clinical services for people with complex needs (principally in order to reduce admissions), relatively few are addressing the broader strategic issues and providing for local educational needs. The presence of multidisciplinary teams, which integrated primary and secondary care clinicians with PCO management, was associated with more comprehensive service provision addressing the needs of all respiratory patients. Future research needs to provide insight into the structures, processes and inter-professional relationships that facilitate development of clinical, educational and policy initiatives which aim to enhance local delivery of respiratory care.
利用诸如医疗保健长期病症金字塔等框架，英格兰和威尔士的初级保健组织（PCO）正在探索为患有长期呼吸道疾病的人群开发服务的方法。我们旨在探究当前及计划中的呼吸道服务以及负责变革的人员的角色。
从英格兰和威尔士的30个PCO中选取了一个有目的的样本。
对负责推动呼吸道服务重新配置的人员进行半结构化电话访谈。对访谈录音进行转录和编码，并确定主题。使用矩阵探讨推动变革的团队组成与所提供服务广度之间的关联。
除了两个PCO外，其他所有PCO都描述了为满足呼吸道疾病患者需求而开发的临床服务，通常侧重于预防慢性阻塞性肺疾病（COPD）患者的住院治疗。尽管大多数PCO都认识到需要制定服务发展的战略方法并满足初级保健专业人员的教育需求，但相对较少的PCO描述了针对这些问题的明确制定的计划。初级和二级保健临床医生的参与与广泛的多方面服务发展方法相关。团队合作往往具有挑战性，但对参与者来说可能会有回报，并且可能导致目标的有效协调一致。PCO的即将合并以及首要的财务限制导致了一种“不稳定”的环境，这对计划的成功实施构成了挑战。
虽然大多数PCO正在为有复杂需求的人群（主要是为了减少住院人数）开发临床服务，但相对较少的PCO正在解决更广泛的战略问题并满足当地的教育需求。多学科团队的存在，即将初级和二级保健临床医生与PCO管理层整合在一起，与更全面地满足所有呼吸道患者需求的服务提供相关。未来的研究需要深入了解有助于制定旨在加强当地呼吸道护理服务的临床、教育和政策举措的结构、流程和专业间关系。
