Bolmsjö Beata Borgström, Strandberg Eva Lena, Midlöv Patrik, Brorsson Annika
Center for Primary Health Care Research, Department of Clinical Sciences in Malmö, Lund University, Jan Waldenströms gata 35, SE 205 02, Malmö, Sweden.
Blekinge Centre of Competence, Karlskrona, Sweden.
BMC Fam Pract. 2015 Aug 28;16:111. doi: 10.1186/s12875-015-0326-6.
Swedish nursing homes (NH) have limited capacity. As a result elderly people living in NH represent the part of the elderly population in most need of care. In Sweden a General Practitioner (GP) is usually responsible for the medical care of all subjects living in a NH. The residents in NH seldom have adequate pharmacological treatment according to diagnosis and often have polypharmacy and/or inappropriate medical treatment regarding concerns of declining renal function. What prevents optimal care for the elderly is multifaceted, but there is limited research on how GPs experience their work with the elderly in NH in Sweden. This study aims to illuminate the GPs' work with the elderly in NH to provide input on how the care can be improved, as well as to identify potential obstacles for good quality of care.
This qualitative study is based on individual semi-structured interviews with 12 GPs and a follow-up focus group discussion with six of the interviewed GPs. The interviews were analysed with systematic text condensation, with the process leading to identify categories and themes. Thereafter, the themes were discussed among six of the participating GPs in a focus group interview.
Two main themes were identified: concern for the patient and sustainable working conditions. The principal focus for the GPs was to contribute to the best possible quality of life for the patients. The GPs described discordance between the demand from staff for medications and the patients' actual need of care. GPs found their work with NH enjoyable. Even though the patients at the NH often suffered from multiple illnesses, which could lead to difficult decisions being made, the doctors felt confident in their role by having a holistic view of the patient in tandem with reliable support from the nurse at the NH.
Working with NH patients was considered important and meaningful, with the GPs striving for the patient's well-being with special consideration to the continuum of ageing. A continuous and well-functioning relationship between the GP and the nurse was crucial for the patients' well-being.
瑞典养老院的接纳能力有限。因此，住在养老院的老年人是最需要护理的老年人群体。在瑞典，全科医生通常负责为住在养老院的所有人员提供医疗护理。养老院的居民很少能根据诊断得到充分的药物治疗，而且由于担心肾功能下降，他们经常存在多种药物联合使用和/或不适当的药物治疗情况。阻碍为老年人提供最佳护理的因素是多方面的，但关于瑞典全科医生如何看待他们在养老院与老年人的工作，相关研究有限。本研究旨在阐明全科医生在养老院与老年人的工作情况，为如何改善护理提供参考，并识别优质护理的潜在障碍。
本定性研究基于对12名全科医生的个人半结构化访谈以及与其中6名受访全科医生的后续焦点小组讨论。访谈采用系统文本浓缩法进行分析，该过程旨在识别类别和主题。此后，在焦点小组访谈中，6名参与的全科医生对这些主题进行了讨论。
确定了两个主要主题：对患者的关注和可持续的工作条件。全科医生的主要关注点是为患者提供尽可能好的生活质量。全科医生描述了工作人员对药物的需求与患者实际护理需求之间的不一致。全科医生发现他们在养老院的工作令人愉快。尽管养老院的患者经常患有多种疾病，这可能导致做出艰难的决策，但医生们通过对患者有整体的看法并得到养老院护士可靠的支持，对自己的角色充满信心。
与养老院患者合作被认为是重要且有意义的，全科医生努力促进患者的福祉，特别考虑到老龄化的连续性。全科医生和护士之间持续且良好运作的关系对患者的福祉至关重要。
