Lafortune Claire, Huson Kelsey, Santi Selena, Stolee Paul
School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
Institutional Research, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
BMC Geriatr. 2015 Apr 30;15:57. doi: 10.1186/s12877-015-0052-x.
Older persons are often poorly served by existing models of community-based primary health care (CBPHC). We sought input from clients, informal caregivers, and health care providers on recommendations for system improvements.
Focus group interviews were held with clients, informal caregivers, and health care providers in mid-sized urban and rural communities in Ontario. Data were analyzed using a combination of directed and emergent coding. Results were shared with participants during a series of feedback sessions.
An extensive list of barriers, facilitators, and recommended health system improvements was generated. Barriers included poor system integration and limited access to services. Identified facilitators were person and family-focused care, self-management resources, and successful collaborative practice. Recommended system improvements included expanding and integrating care teams, supports for system navigation, and development of standardized information systems and care pathways.
Older adults still experience frustrating obstacles when trying to access CBPHC. Identified barriers and facilitators of improved system integration aligned well with current literature and Wagner's Chronic Care Model. Additional work is needed to implement the recommended improvements and to discern their impact on patient and system outcomes.
现有的社区初级卫生保健（CBPHC）模式往往无法很好地满足老年人的需求。我们征求了客户、非正式照护者和医疗服务提供者对于系统改进建议的意见。
在安大略省的中型城市和农村社区，我们与客户、非正式照护者和医疗服务提供者进行了焦点小组访谈。使用定向编码和浮现编码相结合的方法对数据进行分析。在一系列反馈会议期间，将结果分享给了参与者。
列出了一份关于障碍、促进因素和建议的卫生系统改进措施的详尽清单。障碍包括系统整合不佳和服务获取受限。已确定的促进因素是以个人和家庭为中心的护理、自我管理资源以及成功的协作实践。建议的系统改进措施包括扩大和整合护理团队、提供系统导航支持以及开发标准化信息系统和护理路径。
老年人在尝试获取社区初级卫生保健时仍会遇到令人沮丧的障碍。已确定的改善系统整合的障碍和促进因素与当前文献以及瓦格纳慢性病照护模式高度契合。需要开展更多工作来实施建议的改进措施，并了解其对患者和系统结果的影响。
