Division of Rheumatology, McGill University Health Centre (MUHC), Montreal, QC, Canada.
Clin Rheumatol. 2010 Jun;29(6):645-57. doi: 10.1007/s10067-010-1383-9. Epub 2010 Feb 3.
Our study sought to identify barriers to optimal care for individuals with rheumatoid arthritis (RA). Our study was set in a population with universal access to comprehensive health care in the context of a university hospital health network. Using purposive sampling, we invited RA patients, health professionals, and decision makers from urban and rural regions to participate in structured focus group interviews. Content analysis was performed to determine themes emerging from the data. We identified four general themes. First, initial barriers to optimal care for people begin before primary care contact, at the level of the general population and/or related to primary care access. Second, many factors (at the patient, physician, and system level) influenced how quickly a patient is referred from primary to specialty care. Third, after referral, multiple comanagement issues influence patient outcomes. Fourth, optimizing RA care requires adequate resources. Participants emphasized the need for more education (of patients, of health care providers, and within the general community), better communication between and among patients and health care providers, and more efficient use of existing resources. Our work provides insights regarding barriers to and facilitators of optimal care in RA. Further work with these stakeholder groups in our health care region will examine potential solutions and the feasibility of their implementation. Our work provides an example of how research can assist stakeholder leaders in creating structured and incremental plans to improve health care delivery for persons with chronic diseases like RA.
我们的研究旨在确定类风湿关节炎（RA）患者获得最佳治疗的障碍。我们的研究是在一个拥有大学医院健康网络的全民享有综合医疗保健的人群中进行的。我们采用目的性抽样，邀请了城市和农村地区的 RA 患者、卫生专业人员和决策者参与结构化焦点小组访谈。采用内容分析法确定数据中出现的主题。我们确定了四个总体主题。首先，人们获得最佳治疗的最初障碍始于初级保健接触之前，存在于普通人群中和/或与初级保健的可及性有关。其次，许多因素（在患者、医生和系统层面）影响着患者从初级保健向专科保健的转诊速度。第三，转诊后，多种共同管理问题会影响患者的结局。第四，优化 RA 治疗需要充足的资源。参与者强调需要对患者、卫生保健提供者以及更广泛的社区进行更多的教育，需要改善患者与卫生保健提供者之间及内部的沟通，并需要更有效地利用现有资源。我们的工作提供了有关 RA 最佳治疗的障碍和促进因素的见解。在我们的医疗保健区域与这些利益相关者群体进一步合作，将研究潜在的解决方案及其实施的可行性。我们的工作为研究如何帮助利益相关者领导者为慢性疾病（如 RA）患者制定结构化和渐进式计划以改善医疗服务提供了一个范例。
