Department of Rheumatology King's College London School of Medicine, London, UK.
BMC Musculoskelet Disord. 2011 Jan 17;12:19. doi: 10.1186/1471-2474-12-19.
A number of recent reports published in the UK have put the quality of care of adults with Rheumatoid Arthritis (RA) centre stage. These documents set high standards for health care professionals and commissioning bodies that need to be implemented into routine clinical practice. We therefore have obtained the views of recipients and providers of care in inner city settings as to what they perceive are the barriers to providing integrated care.
We conducted focus groups and face to face interviews between 2005-8 with 79 participants (patients, carers, specialist medical and nursing outpatient staff and general practitioners (GPs)) working in or attending three hospitals and three primary care trusts (PCT).
Three barriers were identified that stood in the way of seamless integrated care in RA from the perspective of patients, carers, specialists and GPs: (i) early referral (e.g. 'gate keeper's role of GPs); (ii) limitations of ongoing care for established RA (e.g. lack of consultation time in secondary care) and (iii) management of acute flares (e.g. pressure on overbooked clinics).
This timely study of the multi-perspective views of recipients and providers of care was conducted during the time of publications of many important reports in the United Kingdom (UK) that highlighted key components in the provision of high quality care for adults with RA. To achieve seamless care across primary and secondary care requires organisational changes, greater personal and professional collaboration and GP education about RA.
英国近期发布了多项报告，强调了类风湿关节炎（RA）成年患者的护理质量问题。这些文件为医疗保健专业人员和委托机构设定了高标准，需要将其纳入常规临床实践中。因此，我们已经了解了市中心地区的护理接受者和提供者对提供综合护理的障碍的看法。
我们在 2005 年至 2008 年间，通过焦点小组和面对面访谈，对 79 名参与者（患者、护理人员、专科医疗和护理门诊工作人员以及全科医生）进行了调查，他们工作或参与了三家医院和三家初级保健信托机构。
从患者、护理人员、专家和全科医生的角度来看，有三个障碍阻碍了 RA 的无缝综合护理：（i）早期转诊（例如全科医生的“守门人”角色）；（ii）既定 RA 持续护理的局限性（例如在二级保健中缺乏咨询时间）；（iii）急性发作的管理（例如预约过多的诊所的压力）。
这项及时的研究，从护理接受者和提供者的多重视角出发，对英国发布的许多重要报告进行了研究，这些报告强调了为 RA 成年患者提供高质量护理的关键组成部分。要实现初级保健和二级保健之间的无缝护理，需要组织变革、更大的个人和专业合作以及全科医生对 RA 的教育。
