Social Policy Research Unit, University of York, UK.
Health Soc Care Community. 2011 Nov;19(6):576-601. doi: 10.1111/j.1365-2524.2011.01001.x. Epub 2011 Jul 1.
Health and social care systems experience difficulty in delivering the continuity of care that service users want. Lack of clarity about what continuity means hinders service organisation and delivery. The NIHR Service Delivery and Organisation programme funded a series of research projects to tackle this conceptual confusion, and subsequently commissioned a review of the projects' outputs. The aim was to assess how the projects had progressed conceptualisation and measurement of continuity, and increased knowledge about what influenced it. This paper concentrates on two questions: what is continuity of care, and what influences it? We reviewed the projects' outputs and extracted data using techniques adapted from systematic reviewing methods. We treated the outputs as 'transcripts' and used the Framework approach to qualitative analysis to handle them. This maintained the coherence of individual projects while allowing cross-project themes to emerge. We then produced a narrative synthesis of findings. Service users and carers valued good relationships with professionals; this did not always mean seeing the same person and encompassed trust, the professional's style and communication skills, and the time made available. Service users and carers also valued understanding the patient's condition and treatment. This went beyond giving information, to include communication that recognised individuals' capacities and that was skilled, given sufficient time, and from a trusted source. Service users valued co-ordination between professionals and services; this covered communication, planning, and services' storage and use of information about them. Co-ordination with carers and others was also important. Experiences of continuity were influenced by service users' characteristics and circumstances, care trajectories, the structure and administration of services, professionals' characteristics, carer participation, the wider context of the 'whole person' and satisfaction. The review highlighted how service users, carers and professionals construct continuity dynamically between themselves. This has implications for both professional training and service users' expectations.
医疗保健系统在提供用户所需的连续性护理方面存在困难。对连续性意味着什么缺乏明确性阻碍了服务的组织和提供。NIHR 服务交付和组织计划资助了一系列研究项目来解决这一概念混淆问题，并随后委托对项目成果进行审查。目的是评估这些项目在概念化和测量连续性方面的进展情况，以及增加对影响连续性的因素的了解。本文重点关注两个问题：什么是连续性护理，以及什么因素会影响它？我们审查了项目的成果，并使用从系统评价方法中改编的技术提取数据。我们将成果视为“转录本”，并使用定性分析框架方法来处理它们。这保持了各个项目的一致性，同时允许出现跨项目主题。然后，我们对研究结果进行了叙述性综合。服务用户和护理人员重视与专业人员的良好关系；这并不总是意味着与同一个人见面，还包括信任、专业人员的风格和沟通技巧，以及提供的时间。服务用户和护理人员还重视了解患者的病情和治疗。这不仅仅是提供信息，还包括承认个人能力的沟通，以及有足够时间、由可信来源进行的沟通。服务用户重视专业人员和服务之间的协调；这涵盖了沟通、计划以及服务存储和使用有关他们的信息。与护理人员和其他人的协调也很重要。连续性的体验受到服务用户的特征和情况、护理轨迹、服务的结构和管理、专业人员的特征、护理人员的参与、“整个人”的更广泛背景以及满意度的影响。审查强调了服务用户、护理人员和专业人员如何在他们之间动态构建连续性。这对专业培训和服务用户的期望都有影响。
