Reckrey Jennifer M, Gettenberg Gabrielle, Ross Helena, Kopke Victoria, Soriano Theresa, Ornstein Katherine
a Icahn School of Medicine, Mount Sinai , New York , New York , USA.
Soc Work Health Care. 2014;53(4):330-43. doi: 10.1080/00981389.2014.884041.
The growing homebound population has many complex biomedical and psychosocial needs and requires a team-based approach to care (Smith, Ornstein, Soriano, Muller, & Boal, 2006). The Mount Sinai Visiting Doctors Program (MSVD), a large interdisciplinary home-based primary care program in New York City, has a vibrant social work program that is integrated into the routine care of homebound patients. We describe the assessment process used by MSVD social workers, highlight examples of successful social work care, and discuss why social workers' individualized care plans are essential for keeping patients with chronic illness living safely in the community. Despite barriers to widespread implementation, such social work involvement within similar home-based clinical programs is essential in the interdisciplinary care of our most needy patients.
日益增多的居家人口有许多复杂的生物医学和心理社会需求,需要采用基于团队的护理方法(史密斯、奥恩斯坦、索里亚诺、穆勒和博尔,2006年)。西奈山上门医生项目(MSVD)是纽约市一个大型的跨学科居家初级护理项目,拥有一个充满活力的社会工作项目,该项目已融入到居家患者的日常护理中。我们描述了MSVD社会工作者所采用的评估过程,突出了成功的社会工作护理案例,并讨论了为什么社会工作者的个性化护理计划对于让慢性病患者安全地生活在社区中至关重要。尽管广泛实施存在障碍,但在类似的居家临床项目中,这种社会工作参与对于我们最需要帮助的患者的跨学科护理至关重要。