Sandín-Vázquez M, Conde-Espejo P
Departamento de Ciencias Sanitarias y Médico Sociales, Facultad de Medicina, Universidad de Alcalá, Alcalá de Henares, Madrid, España.
Rev Calid Asist. 2010 Jan-Feb;25(1):21-7. doi: 10.1016/j.cali.2009.07.007. Epub 2009 Oct 25.
To find out how health professionals in Primary Care (PC) perceive the definition criteria for frequent attendance, as well as their perceptions of the reasons for the visits of patients referred to as frequent attenders, their situations and their relationships with them.
We performed a qualitative study using semi-structured interviews in Primary Care centers of six health areas of the Community of Madrid. Eighteen interviews were conducted, three per area (two physicians and one nurse). Structural sampling was carried out with regards to the variables that could influence the discourse: health area, occupation, sex and number of years worked. The transcriptions were analyzed by two investigators who gave a consensus interpretation.
The proportion of frequent attenders varies according to each professional and it is defined more by quality reasons than by number of visits. They make appointments associated with chronic diseases, but also for psychosocial or work problems. There are frequent attenders of all ages and both sexes, and the doctor-patient relationship depends on each individual case.
Frequent attendance is defined by the professionals by a number of qualitative criteria in which the number of visits is of little importance. The reasons for consultation and patient characteristics are numerous, so a unique profile cannot be determined. A common factor in the discourses is that many of the frequent attenders' reasons for consultation were psychosocial problems, so streamlining coordination with psychosocial resources would help to make PC consultations more efficient and effective.
了解基层医疗(PC)中的卫生专业人员如何看待频繁就诊的定义标准,以及他们对被称为频繁就诊者的患者就诊原因、状况及其与患者关系的看法。
我们在马德里自治区六个卫生区域的基层医疗中心进行了一项定性研究,采用半结构式访谈。共进行了18次访谈,每个区域3次(两名医生和一名护士)。针对可能影响话语的变量进行了结构抽样:卫生区域、职业、性别和工作年限。由两名研究者对访谈记录进行分析并给出共识性解释。
频繁就诊者的比例因每位专业人员而异,其定义更多地取决于质量原因而非就诊次数。他们预约就诊不仅与慢性病有关,也与心理社会或工作问题有关。各年龄段和性别的患者中都有频繁就诊者,医患关系因具体个案而异。
专业人员通过一些定性标准来定义频繁就诊,其中就诊次数并不重要。就诊原因和患者特征多种多样,因此无法确定一个独特的概况。讨论中的一个共同因素是,许多频繁就诊者的就诊原因是心理社会问题,因此简化与心理社会资源的协调将有助于提高基层医疗咨询的效率和效果。