Dalsted Rikke Juul, Guassora Ann Dorrit, Thorsen Thorkil
The Research Unit for General Practice and Section of GeneralPractice, Department of Public Health,University of Copenhagen, CSS, Øster Farimagsgade 5-24, 1014 Copenhagen, Denmark.
Dan Med Bull. 2011 Jan;58(1):A4222.
Despite initiatives to integrate treatment and care across organisations, patient trajectories in Danish health-care are not well coordinated. Coordination among many health-care professionals is essential, and it is frequently suggested that a single person should perform the task of coordination. The aim of the article is to discuss whether general practitioners (GPs) may play a coordinating role for individual patients in Danish cancer treatment.
This study is based on individual interviews and focus groups analyzed by meaning condensation.
The GP's potential to coordinate patient trajectories was limited by lack of involvement of the GPs by other health-care professionals and lack of needed information. Furthermore, many patients do not regard their GP as a coordinator. Patients who contacted their GP during treatment typically had a close relationship with their GP prior to their cancer diagnosis. In cases with a more distant relationship, patients did not see a need for the GP's involvement. The majority of patients' trajectories were decided within hospitals. The level of information provided to GPs varied much between hospitals and wards. In the majority of cases, GPs had no access to information or were not informed about hospital decisions affecting the patients' trajectories, and they were therefore unable to perform a coordinating role.
GPs only played a minor or no role at all as coordinators of individual cancer patient trajectories. The findings of the present study question the idea that coordination throughout the entire health-care system may be assigned to a single individual as the involved parties belong to different organizations with different goals, managements and economic resources.
尽管有举措推动各机构间的治疗与护理整合，但丹麦医疗保健中的患者就医轨迹并未得到很好的协调。众多医疗保健专业人员之间的协调至关重要，且人们常建议应由一人承担协调任务。本文旨在探讨全科医生（GP）在丹麦癌症治疗中是否可为个体患者发挥协调作用。
本研究基于通过意义浓缩分析的个人访谈和焦点小组。
全科医生协调患者就医轨迹的潜力受到其他医疗保健专业人员未让全科医生参与以及缺乏所需信息的限制。此外，许多患者并不将其全科医生视为协调者。在治疗期间联系全科医生的患者通常在癌症诊断前就与全科医生关系密切。在关系较为疏远的情况下，患者认为无需全科医生参与。大多数患者的就医轨迹是在医院内决定的。各医院和病房向全科医生提供的信息水平差异很大。在大多数情况下，全科医生无法获取信息或未被告知影响患者就医轨迹的医院决策，因此他们无法发挥协调作用。
全科医生在个体癌症患者就医轨迹协调方面仅发挥了次要作用或根本未发挥作用。本研究结果对将整个医疗保健系统的协调工作分配给单个个体这一观点提出了质疑，因为相关各方属于具有不同目标、管理方式和经济资源的不同组织。
