Maxwell Leigh, Odukoya Olufunmilola K, Stone Jamie A, Chui Michelle A
Department of Communication Studies, Edgewood College, Madison, WI 53711, USA.
Department of Pharmacy and Therapeutics, University of Pittsburgh, School of Pharmacy, Pittsburgh, PA 15261, USA.
Res Social Adm Pharm. 2014 Nov-Dec;10(6):824-836. doi: 10.1016/j.sapharm.2013.12.002. Epub 2013 Dec 22.
In an effort to increase cost-effectiveness of health care and reduce overall costs, patient-centered medical homes have been proposed to spur fundamental changes in the way primary care is delivered. One of the chief principles that describe a patient-centered medical home is that care is organized across all elements of the broader health care system, including community pharmacies.
To identify and describe challenges derived from a conflict management framework to a physician-pharmacist approach to coordinating patient care.
A descriptive, exploratory, non-experimental study was conducted in Wisconsin (U.S. State) from June to December, 2011. Data were collected through two rounds of face-to-face interviews with physicians and community pharmacists. The first round involved one-on-one interviews with pharmacists and physicians. The second round brought pharmacist-physician dyads together in an open-ended interview exploring issues raised in the first round. Content analysis was guided by a conflict management conceptual framework using NVivo 10 qualitative software.
A total of four major themes emerged from the conflict analysis of interviews that illustrate challenges to coordinated patient care: Scarce resources, technology design and usability, insurance constraints, and laws and policy governing patient care. The study findings indicate that both groups of health care professionals work within an environment of conflict and have to negotiate the challenges and strains that exist in the current health care system. Their need to work together, or interdependence, is primarily challenged by scarce resources and external interference.
Efforts to coordinate patient care through teams of inter-professional health care providers will be more successful if they acknowledge the inherent conflict that exists. Efforts should be made to provide an infrastructure for interdependence and to support interpersonal communication.
为提高医疗保健的成本效益并降低总体成本，有人提出以患者为中心的医疗之家，以推动初级保健提供方式的根本性变革。描述以患者为中心的医疗之家的主要原则之一是，医疗服务是在更广泛的医疗保健系统的所有要素中进行组织的，包括社区药房。
确定并描述从冲突管理框架到医生 - 药剂师协调患者护理方法所产生的挑战。
2011年6月至12月在美国威斯康星州进行了一项描述性、探索性、非实验性研究。通过与医生和社区药剂师进行两轮面对面访谈收集数据。第一轮包括与药剂师和医生的一对一访谈。第二轮将药剂师 - 医生二人组合在一起进行开放式访谈，探讨第一轮中提出的问题。使用NVivo 10定性软件，在冲突管理概念框架的指导下进行内容分析。
访谈的冲突分析共产生了四个主要主题，这些主题说明了协调患者护理方面的挑战：资源稀缺、技术设计和可用性、保险限制以及管理患者护理的法律法规。研究结果表明，这两组医疗保健专业人员都在冲突环境中工作，并且必须应对当前医疗保健系统中存在的挑战和压力。他们合作的需求，即相互依存关系，主要受到资源稀缺和外部干扰的挑战。
如果通过跨专业医疗保健提供者团队协调患者护理的努力能够认识到存在的内在冲突，那么这些努力将更有可能取得成功。应该努力提供相互依存的基础设施并支持人际沟通。
