英国初级保健中全科医生对儿童质量标志物的看法：一项定性研究。
General practitioners' views on quality markers for children in UK primary care: a qualitative study.
机构信息
Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, UK.
出版信息
BMC Fam Pract. 2012 Sep 14;13:92. doi: 10.1186/1471-2296-13-92.
BACKGROUND
Children make up about 20% of the UK population and caring for them is an important part of a general practitioner's (GP's) workload. However, the UK Quality Outcomes Framework (pay-for-performance system) largely ignores children - less than 3% of the quality markers relate to them. As no previous research has investigated whether GPs would support or oppose the introduction of child-specific quality markers, we sought their views on this important question.
METHODS
Qualitative interview study with 20 GPs from four primary care trusts in Thames Valley, England. Semi-structured interviews explored GPs' viewpoints on quality markers and childhood conditions that could be developed into markers in general practice. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and used constant comparative method to look for anticipated and emergent themes as the analysis progressed.
RESULTS
All the GPs interviewed supported the development of 'benchmarks' or 'standards' to measure and improve quality of care for children. However no consensus was expressed about the clinical conditions for which quality markers should be developed. Many participants reflected on their concerns about unmet health care needs and felt there may be opportunities to improve proactive care in 'at risk' groups. Some expressed feelings of powerlessness that important child-relevant outcomes such as emergency department visits and emergency admissions were out of their control and more directly related to public health, school and parents/carers. The importance of access was a recurrent theme; access to urgent general practice appointments for children and GP access to specialists when needed.
CONCLUSION
The GPs expressed support for the development of quality markers for the care of children in UK general practice. However, they flagged up a number of important challenges which need to be addressed if markers are to be developed that are measureable, targeted and within the direct control of primary care. Easy access to primary and secondary care appointments may be an important benchmark for commissioners of care.
背景
儿童约占英国人口的 20%，照顾他们是全科医生（GP）工作量的重要组成部分。然而，英国质量成果框架（绩效付费系统）在很大程度上忽视了儿童——不到 3%的质量指标与他们有关。由于之前没有研究调查全科医生是否会支持或反对引入针对儿童的特定质量指标，我们就这个重要问题征求了他们的意见。
方法
对英格兰泰晤士河谷四个初级保健信托的 20 名全科医生进行了定性访谈研究。半结构化访谈探讨了全科医生对质量指标和可在全科实践中发展为指标的儿童疾病的观点。访谈进行了录音，并逐字记录。分析采用主题分析法，并使用恒定比较法随着分析的进行寻找预期和新出现的主题。
结果
所有接受采访的全科医生都支持制定“基准”或“标准”来衡量和提高儿童保健质量。然而，对于应制定质量指标的临床病症，没有达成共识。许多参与者反思了他们对未满足的医疗保健需求的关注，并认为在“高危”群体中可能有机会改善主动护理。一些人感到无能为力，因为重要的与儿童相关的结果，如急诊科就诊和紧急入院，不受他们控制，更多地与公共卫生、学校和家长/照顾者直接相关。获得医疗服务的机会是一个反复出现的主题；为儿童提供紧急全科医生预约，以及当需要时全科医生获得专科医生的帮助。
结论
全科医生对英国普通实践中儿童护理质量指标的发展表示支持。然而，他们提出了一些重要的挑战，如果要开发可衡量、有针对性且在初级保健直接控制范围内的指标，这些挑战需要得到解决。方便获得初级和二级保健预约可能是护理服务购买者的一个重要基准。
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