Department of Geography, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada.
BMC Fam Pract. 2012 Jul 16;13:69. doi: 10.1186/1471-2296-13-69.
Unattached patients do not have a regular primary care provider. Initiatives are being developed to increase attachment rates across Canada. Most existing attention paid to patient unattachment has focused on quantifying the problem and health system costs. Our purpose is to qualitatively identify the implications of chronically ill patients' experiences of unattachment for health policy and planning to provide policy-relevant insights for Canadian attachment initiatives.
Three focus groups were conducted with marginalized chronically ill individuals residing in a mid-sized city in British Columbia who are unattached to a family doctor. We use the term marginalized as a descriptor to acknowledge that by virtue of their low socio-economic status and lack of attachment the participants are marginalized in Canada's health care system Focus groups were structured as an open conversation organized around a series of probing questions. They were digitally recorded and transcribed verbatim. Thematic analysis was employed.
Twenty-six individuals participated in the focus groups. The most common chronic illnesses reported were active drug addiction or recovery (and their associated symptoms), depression, arthritis, and hepatitis C. Participants identified life transitions as being the root cause for not having a family doctor. There was a strong sense that unsuccessful attempts to get a family doctor reflected that they were undesirable patients. Participants wanted to experience having a trusting relationship with a regular family doctor as they believed it would encourage greater honesty and transparency. One of the main health concerns regarding lack of access to a regular family doctor is that participants lacked access to preventative care. Participants were also concerned about having a discontinuous medical record due to unattachment.
Participants perceived that there are many benefits to be had by having attachment to a regular family doctor and that experiencing unattachment challenged their health and access to health care. We encourage more research to be done on the lived experience of unattachment in order to provide on-the-ground insights that policy-makers require in order to develop responsive, patient-centred supports and programs.
未依附患者没有固定的初级保健提供者。加拿大正在制定各项计划来提高依附率。现有大多数关注患者未依附问题的注意力都集中在量化问题和卫生系统成本上。我们的目的是从质量上确定慢性病患者依附体验对卫生政策和规划的影响，为加拿大的依附计划提供与政策相关的见解。
在不列颠哥伦比亚省一个中等城市，对未依附家庭医生的边缘化慢性疾病患者进行了三次焦点小组讨论。我们使用“边缘化”一词来描述，因为这些参与者由于社会经济地位低和缺乏依附，在加拿大的医疗保健系统中处于边缘化地位。焦点小组的结构是围绕一系列探究性问题进行的开放式对话。对小组讨论进行了数字记录和逐字转录。采用主题分析。
26 人参加了焦点小组。报告的最常见慢性病是药物滥用或康复（及其相关症状）、抑郁症、关节炎和丙型肝炎。参与者将生活转变确定为没有家庭医生的根本原因。他们强烈地感觉到，无法成功获得家庭医生，反映出他们是不受欢迎的患者。参与者希望体验与常规家庭医生建立信任关系，因为他们认为这将鼓励更大的诚实和透明度。参与者对无法获得常规家庭医生的主要健康关注之一是，他们缺乏预防保健的机会。参与者还担心由于未依附而导致医疗记录不连续。
参与者认为与常规家庭医生建立依附关系有很多好处，并且体验未依附会影响他们的健康和获得医疗保健的机会。我们鼓励对未依附的实际体验进行更多的研究，以便为政策制定者提供实地见解，从而制定出响应性强、以患者为中心的支持和计划。
