Dupuis Martin, Marshall John K, Hayes Sean M, Cytryn Kayla, Murray Suzanne
AXDEV Group Inc, Brossard, Quebec J4W 3H2, Canada.
Can J Gastroenterol. 2009 Dec;23(12):805-10. doi: 10.1155/2009/384926.
OBJECTIVE: A national needs assessment of Canadian gastroenterologists and gastroenterology nurses was undertaken to determine the perceived and unperceived educational and performance barriers to caring for patients with Crohn's disease (CD). METHODS: A triangulated, mixed-method approach (qualitative and quantitative) was used to determine the nature and extent of knowledge gaps and barriers in the care of patients with CD. RESULTS: Qualitative interviews were conducted with nine gastroenterologists, four gastroenterology nurses and nine patients with CD. Based on this exploratory research, a survey was designed and launched nationally (37 gastroenterologists, 36 gastroenterology nurses). Findings indicated that Canadian gastroenterologists and gastroenterology nurses lacked clarity regarding their roles and responsibilities across the continuum of CD care, and face communication gaps within the health care team, undermining their effectiveness. Gastroenterologists identified challenges in optimal diagnosis due to unclear testing and diagnostic criteria. They recognized knowledge gaps when treating patient subgroups and in prescribing biological therapies. Furthermore, gastroenterologists self-identified gaps in skill, knowledge, and confidence in monitoring disease progression and effectively assessing response to therapy. When managing patients with CD, gastroenterologists expressed challenges with patient issues outside their domain of medical expertise, particularly with the skills needed to facilitate effective patient communication and education that would enhance adherence to recommended treatments. CONCLUSIONS: Educational initiatives should address diagnostic and treatment guidelines, as well as enhancement of clinical performance gaps in health care team processes and the patient-professional therapeutic relationship. To impact care and patient outcomes, these initiatives must be relevant to clinical practice settings and applicable to the practice context.
目的:对加拿大胃肠病学家和胃肠病学护士进行全国性需求评估,以确定在护理克罗恩病(CD)患者时所感知到的和未被感知到的教育及绩效障碍。 方法:采用三角测量、混合方法(定性和定量)来确定CD患者护理中知识差距和障碍的性质及程度。 结果:对9名胃肠病学家、4名胃肠病学护士和9名CD患者进行了定性访谈。基于这项探索性研究,设计并在全国范围内开展了一项调查(37名胃肠病学家、36名胃肠病学护士)。结果表明,加拿大胃肠病学家和胃肠病学护士在CD护理连续过程中的角色和职责方面缺乏明确认识,并且在医疗团队内部面临沟通差距,这削弱了他们的工作成效。胃肠病学家指出,由于检测和诊断标准不明确,在最佳诊断方面存在挑战。他们认识到在治疗患者亚组和开具生物疗法处方时存在知识差距。此外,胃肠病学家自我认定在监测疾病进展和有效评估治疗反应方面存在技能、知识和信心方面的差距。在管理CD患者时,胃肠病学家表示在处理超出其医学专业领域的患者问题时面临挑战,特别是在促进有效的患者沟通和教育以提高对推荐治疗的依从性所需的技能方面。 结论:教育举措应涉及诊断和治疗指南,以及改善医疗团队流程和患者 - 专业人员治疗关系中的临床表现差距。为了影响护理和患者结局,这些举措必须与临床实践环境相关且适用于实践背景。
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