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以毛利患者与主要为非毛利医生的诊疗关系连续性对患者参与度的意义:一项定性研究的结果

The significance of relational continuity of care for Māori patient engagement with predominantly non-Māori doctors: findings from a qualitative study.

作者信息

Reid Jennifer, Cormack Donna, Crowe Marie

机构信息

Christchurch School of Medicine, University of Otago, New Zealand.

Te Rōpū Rangahau Hauora a Eru Pōmare, University of Otago, New Zealand.

出版信息

Aust N Z J Public Health. 2016 Apr;40(2):120-5. doi: 10.1111/1753-6405.12447. Epub 2015 Sep 3.

Abstract

OBJECTIVE

This qualitative study explored self-reported experiences of primary healthcare among a sample of urban Māori adults. This paper specifically focuses on the theme of relational continuity of care identified in participant discussions of access and engagement with their predominantly non-Māori general practitioners (GPs).

METHODS

The study involved a purposively selected subsample (n=42) of the Christchurch Māori cohort of the Hauora Manawa Community Heart Study (n=244). Participants took part in in-depth interviews, which were transcribed and analysed thematically.

RESULTS

Analysis identified compromised access to a preferred GP as a principal barrier to receiving quality and non-discriminatory care from predominantly non-Māori clinicians. In contrast to discussions of healthcare provided by usual GPs, episodic encounters with non-regular clinicians were commonly framed as experiences discouraging utilisation and the perceived value of primary healthcare.

CONCLUSIONS

Facilitating relational continuity of care for Māori patients and their clinicians may contribute towards mediating determinants of inequality at the clinical interface.

IMPLICATIONS

Reducing significant health disparities between Māori and non-Māori was a key goal of the reconfiguration of primary healthcare in the early 2000s. The role of relational continuity of care in achieving equitable inter-ethnic health outcomes in primary healthcare settings is an important consideration.

摘要

目的

这项定性研究探讨了城市毛利成年人样本中自我报告的初级医疗保健经历。本文特别关注在参与者与主要为非毛利族的全科医生(GP)的就诊和接触讨论中确定的连续性照护关系主题。

方法

该研究涉及豪奥拉马纳瓦社区心脏研究(n = 244)的克赖斯特彻奇毛利队列中有目的选择的子样本(n = 42)。参与者参加了深入访谈,访谈内容被转录并进行了主题分析。

结果

分析确定,难以找到首选的全科医生是从主要为非毛利族的临床医生那里获得高质量和非歧视性医疗服务的主要障碍。与由常规全科医生提供的医疗保健讨论形成对比的是,与非定期临床医生的偶发接触通常被视为不利于初级医疗保健利用和感知价值的经历。

结论

促进毛利患者与其临床医生之间的连续性照护关系可能有助于在临床层面调节不平等的决定因素。

启示

减少毛利人和非毛利人之间显著的健康差距是21世纪初初级医疗保健重新配置的一个关键目标。连续性照护关系在初级医疗保健环境中实现公平的族裔间健康结果方面的作用是一个重要的考虑因素。

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