Boudioni Markella, McLaren Susan, Belling Ruth, Woods Leslie
Institute for Leadership and Service Improvement, Faculty of Health and Social Care, London South Bank University, London, UK.
Patient Prefer Adherence. 2011;5:267-77. doi: 10.2147/PPA.S20361. Epub 2011 Jun 9.
To explore tuberculosis (TB) service users' experiences and satisfaction with care provision.
Thirty-nine percent of all new UK TB cases occur in London. Prevalence varies considerably between and within boroughs. Overall, research suggests inadequate control of London's TB transmission; TB has become a health care priority for all London Primary Care Trusts. Service users' experiences and satisfaction with care provision have not been explored adequately previously.
A qualitative research design, using semi-structured face-to-face interviews was used. Ten service users, purposively selected in key risk groups across London, were interviewed. All interviews were digitally recorded with users' permission, transcribed verbatim, and analyzed thematically.
Participants were treated in local hospitals for 6-12 months. Treatment was administered by TB nurses to inpatients and outpatients receiving directly observed therapy in consultation with medical staff and home visits for complex cases. Two participants did not realize the importance of compliance. Overall, they were satisfied with many TB services' aspects, communication, and service organization. Early access, low suspicion index amongst some GPs, and restricted referral routes were identified as service barriers. Other improvement areas were information provision on drug side effects, diet, nutritional status, and a few health professionals' attitudes. The effects on people varied enormously from minimal impact to psychological shock; TB also affected social and personal aspects of their life. With regard to further support facilities, some positive views on managed accommodation by TB-aware professionals for those with accommodation problems were identified.
This first in-depth study of TB service users' experiences across London offers valuable insights into service users' experiences, providing information and recommendations for a strategic framework for TB service organization and delivery. Overall, further research is needed; TB services - local, national, and international - need to be more closely aligned with service users' complex needs.
探讨结核病服务使用者对医疗服务的体验和满意度。
英国所有新结核病病例中有39%发生在伦敦。各行政区之间以及行政区内部的患病率差异很大。总体而言，研究表明伦敦结核病传播控制不力；结核病已成为伦敦所有初级医疗信托机构的医疗保健重点。此前尚未充分探讨服务使用者对医疗服务的体验和满意度。
采用定性研究设计，通过半结构化面对面访谈进行。从伦敦的关键风险群体中有目的地选取了10名服务使用者进行访谈。所有访谈均在获得使用者许可的情况下进行数字录音，逐字转录，并进行主题分析。
参与者在当地医院接受了6至12个月的治疗。治疗由结核病护士进行，针对住院患者以及接受直接观察治疗的门诊患者，并与医务人员协商，对复杂病例进行家访。两名参与者没有意识到依从性的重要性。总体而言，他们对结核病服务的许多方面、沟通和服务组织感到满意。早期就诊机会、一些全科医生的低怀疑指数以及有限的转诊途径被确定为服务障碍。其他需要改进的方面包括提供有关药物副作用、饮食、营养状况的信息，以及一些医护人员的态度。其影响因人而异，从几乎没有影响到心理冲击；结核病还影响了他们生活的社会和个人方面。关于进一步的支持设施，对于了解结核病的专业人员为有住宿问题的人提供的管理式住宿，有一些积极的看法。
这项对伦敦结核病服务使用者体验的首次深入研究为服务使用者的体验提供了宝贵的见解，为结核病服务组织和提供的战略框架提供了信息和建议。总体而言，还需要进一步研究；地方、国家和国际层面的结核病服务需要更紧密地与服务使用者的复杂需求相匹配。
