Cheffins Tracy E, Twomey Julie A, Grant Jane A, Larkins Sarah L
Townsville General Practice Network, Garbutt BC, Australia.
Aust J Prim Health. 2012;18(2):112-5. doi: 10.1071/PY11021.
Self-management support (SMS) is an important skill for health professionals providing chronic condition management in the primary health care sector. Training in SMS alone does not always lead to its utilisation. This study aimed to ascertain whether SMS is being used, and to identify barriers and enablers for SMS in practice. Health professionals who underwent SMS training were invited to participate in a semi-structured interview. A response rate of 55% (14 of 24) was achieved. All interviewees rated their understanding of the principles of SMS as moderate or better. In relation to how much they use these principles in their practice, several (5 of 14) said minimally or not at all. The tools they were most likely to use were SMART goals (8 of 14) and decision balance (5 of 14). Core skills that were being used included problem solving (11 of 14), reflective listening (13 of 14), open-ended questions (12 of 14), identifying readiness to change (12 of 14) and goal setting (10 of 14). The most important barriers to implementing SMS were current funding models for health care, lack of space and staff not interested in change. The most highly rated enabling strategies were more training for general practitioners and more training for practice nurses; the lowest rated was more training for receptionists. The increasing prevalence of chronic conditions due to ageing and lifestyle factors must be addressed through new ways of delivering primary health care services. Self-management support is a necessary component of such programs, so identified barriers to SMS must be overcome.
自我管理支持(SMS)是初级卫生保健部门中为慢性病患者提供管理服务的卫生专业人员的一项重要技能。仅接受SMS培训并不总能促使其得到应用。本研究旨在确定SMS是否得到了应用,并找出其在实际应用中的障碍和促进因素。接受过SMS培训的卫生专业人员受邀参加一次半结构化访谈。获得了55%(24人中的14人)的回复率。所有受访者对SMS原则的理解程度都评为中等或更好。关于他们在实践中运用这些原则的程度,有几位(14人中的5人)表示极少运用或根本没有运用。他们最有可能使用的工具是SMART目标(14人中的8人)和决策平衡(14人中的5人)。正在使用的核心技能包括解决问题(14人中的11人)、反思性倾听(14人中的13人)、开放式提问(14人中的12人)、确定改变的意愿(14人中的12人)和设定目标(14人中的10人)。实施SMS的最重要障碍是当前的医疗保健资金模式、空间不足以及工作人员对变革不感兴趣。评价最高的促进策略是为全科医生提供更多培训以及为执业护士提供更多培训;评价最低的是为接待员提供更多培训。由于老龄化和生活方式因素导致慢性病患病率不断上升,必须通过提供初级卫生保健服务的新方式来加以应对。自我管理支持是此类项目的必要组成部分,因此必须克服已确定的SMS障碍。