患者在以患者为中心的护理模式中处于什么位置：全膝关节置换患者的扎根理论研究。
Where is the patient in models of patient-centred care: a grounded theory study of total joint replacement patients.
机构信息
Department of Family and Community Medicine, University of Toronto, 500 University Avenue, 5th Floor, Toronto, Ontario M5G 1V7, Canada.
出版信息
BMC Health Serv Res. 2013 Dec 23;13:531. doi: 10.1186/1472-6963-13-531.
BACKGROUND
Patient-centered care ideally considers patient preferences, values and needs. However, it is unclear if policies such as wait time strategies for hip and knee replacement surgery (TJR) are patient-centred as they focus on an isolated episode of care. This paper describes the accounts of people scheduled to undergo TJR, focusing on their experience of (OA) as a chronic disease that has considerable impact on their everyday lives.
METHODS
Semi-structured qualitative interviews were conducted with participants scheduled to undergo TJR who were recruited from the practices of two orthopaedic surgeons. We first used maximum variation and then theoretical sampling based on age, sex and joint replaced. 33 participants (age 38-79 years; 17 female) were included in the analysis. 20 were scheduled for hip replacement and 13 for knee replacement. A constructivist approach to grounded theory guided sampling, data collection and analysis.
RESULTS
While a specific hip or knee was the target for surgery, individuals experienced multiple-joint symptoms and comorbidities. Management of their health and daily lives was impacted by these combined experiences. Over time, they struggled to manage symptoms with varying degrees of access to and acceptance of pain medication, which was a source of constant concern. This was a multi-faceted issue with physicians reluctant to prescribe and many patients reluctant to take prescription pain medications due to their side effects.
CONCLUSIONS
For patients, TJR surgery is an acute intervention in the experience of chronic disease, OA and other comorbidities. While policy has focused on wait time as patient/surgeon decision for surgery to surgery date, the patient's experience does not begin or end with surgery as they struggle to manage their pain. Our findings suggest that further work is needed to align the medical treatment of OA with the current policy emphasis on patient-centeredness. Patient-centred care may require a paradigm shift that is not always evident in current policy and strategies.
背景
以患者为中心的护理理想地考虑了患者的偏好、价值观和需求。然而，目前尚不清楚诸如髋膝关节置换术（TJR）的等待时间策略等政策是否以患者为中心，因为它们关注的是护理的一个孤立事件。本文描述了 scheduled to undergo TJR 的人的描述，重点是他们将 OA 视为一种对日常生活有重大影响的慢性疾病的体验。
方法
我们对 scheduled to undergo TJR 的参与者进行了半结构化的定性访谈，这些参与者是从两位骨科医生的诊所招募的。我们首先根据年龄、性别和关节置换使用最大变异和理论抽样。共有 33 名参与者（年龄 38-79 岁；17 名女性）参与了分析。20 名参与者计划接受髋关节置换，13 名参与者计划接受膝关节置换。扎根理论的建构主义方法指导了抽样、数据收集和分析。
结果
虽然特定的髋关节或膝关节是手术的目标，但个体经历了多关节症状和合并症。他们的健康和日常生活管理受到这些综合体验的影响。随着时间的推移，他们努力控制症状，在获得和接受止痛药物方面程度不同，这是一个持续关注的问题。这是一个多方面的问题，医生不愿意开处方，许多患者由于副作用而不愿意服用处方止痛药物。
结论
对于患者来说，TJR 手术是慢性疾病、OA 和其他合并症的急性干预。虽然政策侧重于等待时间作为患者/医生决定手术到手术日期的时间，但患者的体验并不从手术开始或结束，因为他们努力控制疼痛。我们的研究结果表明，需要进一步努力使 OA 的医疗护理与当前政策对以患者为中心的重视保持一致。以患者为中心的护理可能需要一种范式转变，而这种转变在当前的政策和策略中并不总是明显的。
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