Grant Richard W, Adams Alyce S, Bayliss Elizabeth A, Heisler Michele
Healthc (Amst). 2013 Dec;1(3-4):117-122. doi: 10.1016/j.hjdsi.2013.07.008.
With the aging of the population and continuing advances in health care, patients seen in the primary care setting are increasingly complex. At the same time, the number of screening and chronic condition management tasks primary care providers are expected to cover during brief primary care office visits has continued to grow. These converging trends mean that there is often not enough time during each visit to address all of the patient's concerns and needs, a significant barrier to effectively providing patient-centered care. For complex patients, prioritization of issues to address during a given visit must precede discrete decisions about disease-specific treatment preferences and goals. Negotiating this process of setting priorities represents a major challenge for patient-centered primary care, as patient and provider priorities may not always be aligned. In this review, we present a synthesis of recent research on how patients and providers negotiate the visit process and describe a conceptual model to guide innovative approaches to more effective primary care visits for complex patients based on defining visit priorities. The goal of this model is to inform interventions that maximize the value of available time during the primary care encounter by facilitating communication between a prepared patient who has had time before the visit to identify his/her priorities and an informed provider who is aware of the patient's care priorities at the beginning of the visit. We conclude with a discussion of key questions that should guide future research and intervention development in this area.
随着人口老龄化以及医疗保健的持续进步，在初级保健机构就诊的患者日益复杂。与此同时，在简短的初级保健门诊就诊期间，初级保健提供者预计要完成的筛查和慢性病管理任务数量持续增加。这些趋势相互交织，意味着每次就诊时往往没有足够时间处理患者的所有担忧和需求，这是有效提供以患者为中心的护理的重大障碍。对于复杂患者而言，在确定特定疾病的治疗偏好和目标之前，必须先对就诊期间要解决的问题进行优先级排序。协商确定优先级的过程是以人为本的初级保健面临的一项重大挑战，因为患者和提供者的优先级可能并不总是一致。在本综述中，我们综合了近期关于患者和提供者如何协商就诊过程的研究，并描述了一个概念模型，以指导基于确定就诊优先级的创新方法，为复杂患者提供更有效的初级保健就诊。该模型的目标是通过促进在就诊前有时间确定自身优先级的有准备的患者与在就诊开始时了解患者护理优先级的见多识广的提供者之间的沟通，为干预措施提供信息，从而在初级保健诊疗过程中最大限度地利用可用时间的价值。我们最后讨论了一些关键问题，这些问题应指导该领域未来的研究和干预措施开发。
