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在社区医疗和社会服务环境中迈向为老年人实施以患者为中心的护理:“只有与客户协同合作,才能把事情做好” 。

Moving Toward Implementation of Person-Centered Care for Older Adults in Community-Based Medical and Social Service Settings: "You Only Get Things Done When Working in Concert with Clients".

作者信息

Coulourides Kogan Alexis, Wilber Kathleen, Mosqueda Laura

机构信息

Department of Family Medicine and Geriatrics, Keck School of Medicine of USC, University of Southern California, Alhambra, California.

Davis School of Gerontology, University of Southern California, Los Angeles, California.

出版信息

J Am Geriatr Soc. 2016 Jan;64(1):e8-14. doi: 10.1111/jgs.13876. Epub 2015 Dec 2.

Abstract

Specialized, fragmented acute care is not aligned optimally to serve older adults. Person-centered care (PCC) has emerged as an evidence-based solution that involves enlisting patients as partners in treatment planning. Although several efforts have captured person-centered voices in outpatient care, more information is needed at the organizational and provider level to better understand the feasibility, challenges, and effect of PCC in community-based and social services settings. To assess themes and emerging trends, researchers conducted telephone interviews with leaders at nine organizations providing PCC for older adults. Questions were focused on the legacy of PCC services, whether and how PCC was connected to better quality care, and what tools were used for measuring PCC. Three themes on PCC for older adults emerged. (1) Each organization ascribed to a unique definition and operational structure for PCC. (2) Despite these differences, all organizations specified a strong commitment to PCC. Most noted financial resources and staffing as challenges and opportunities affecting feasibility. (3) Terms such as "patient-centered" care and other PCC synonyms may warrant greater clarification, because ideological differences set these classifications apart. Results from this analysis indicate the lack of a single, established definition for PCC. As interest in and support for PCC mounts, organizations in outpatient medical and community-based settings clearly have undertaken individual efforts to interpret what PCC is and how to provide it. Interview responses reflect this inconsistency, highlighting how staff and financing in particular can bolster or burden the PCC paradigm and what a consensus definition could do for the field.

摘要

专门化、碎片化的急性护理无法最优化地服务老年人。以患者为中心的护理(PCC)已成为一种循证解决方案,该方案涉及让患者成为治疗规划的合作伙伴。尽管已有多项举措在门诊护理中收集了以患者为中心的声音,但在组织和提供者层面仍需要更多信息,以更好地了解PCC在社区和社会服务环境中的可行性、挑战及效果。为了评估主题和新出现的趋势,研究人员对九个为老年人提供PCC的组织的负责人进行了电话访谈。问题集中在PCC服务的遗留问题、PCC是否以及如何与更高质量的护理相关联,以及用于衡量PCC的工具是什么。出现了关于老年人PCC的三个主题。(1)每个组织对PCC都有独特的定义和运营结构。(2)尽管存在这些差异,但所有组织都明确表示对PCC的坚定承诺。大多数组织指出财务资源和人员配备是影响可行性的挑战和机遇。(3)诸如“以患者为中心”的护理及其他PCC同义词等术语可能需要进一步明确,因为意识形态上的差异使这些分类有所不同。该分析结果表明缺乏对PCC的单一、既定定义。随着对PCC的兴趣和支持增加,门诊医疗和社区环境中的组织显然已各自努力去诠释PCC是什么以及如何提供PCC。访谈回复反映了这种不一致性,突出了人员和资金尤其会如何支持或阻碍PCC范式,以及一个共识定义对该领域能起到什么作用。

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