Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada.
Can Fam Physician. 2013 Mar;59(3):e148-55.
The growing number of elderly patients with multiple chronic conditions presents an urgent challenge in primary care. Current practice models are not well suited to addressing the complex health care needs of this patient population.
The primary objective of the IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) clinic was to design and evaluate a new interprofessional model of care for community-dwelling seniors with complex health care needs. A secondary objective was to explore the potential of this new model as an interprofessional training opportunity.
The IMPACT clinic is an innovative new model of interprofessional primary care for elderly patients with complex health care needs. The comprehensive team comprises family physicians, a community nurse, a pharmacist, a physiotherapist, an occupational therapist, a dietitian, and a community social worker. The model is designed to accommodate trainees from each discipline. Patient appointments are 1.5 to 2 hours in length, during which time a diverse range of medical, functional, and psychosocial issues are investigated by the full interprofessional team.
The IMPACT model is congruent with ongoing policy initiatives in primary care reform and enhanced community-based care for seniors. The clinic has been pilot-tested in 1 family practice unit and modeled at 3 other sites with positive feedback from patients and families, clinicians, and trainees. Evaluation data indicate that interprofessional primary care models hold great promise for the growing challenge of managing complex chronic disease.
患有多种慢性病的老年患者人数不断增加,这对初级保健提出了紧迫的挑战。目前的实践模式不太适合满足这一患者群体复杂的医疗保健需求。
IMPACT(老龄化和复杂治疗的多专业实践模式)诊所的主要目标是设计和评估一种新的针对有复杂医疗需求的社区居住老年人的多专业护理模式。次要目标是探索这种新模式作为多专业培训机会的潜力。
IMPACT 诊所是一种针对有复杂医疗需求的老年患者的创新性多专业初级保健新模式。综合团队由家庭医生、社区护士、药剂师、物理治疗师、职业治疗师、营养师和社区社会工作者组成。该模式旨在容纳来自每个学科的学员。患者预约时间为 1.5 至 2 小时,在此期间,由全体多专业团队调查广泛的医疗、功能和社会心理问题。
IMPACT 模式符合初级保健改革和加强面向老年人的社区护理的现行政策举措。该诊所已在 1 个家庭医疗单位进行试点,并在其他 3 个单位进行了模拟,得到了患者和家属、临床医生和学员的积极反馈。评估数据表明,多专业初级保健模式为管理复杂慢性病的日益增长的挑战提供了巨大的希望。