Solan Lauren G, Sherman Susan N, DeBlasio Dominick, Simmons Jeffrey M
Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
SNS Research, Cincinnati, Ohio.
Acad Pediatr. 2016 Jul;16(5):453-459. doi: 10.1016/j.acap.2016.03.003. Epub 2016 Mar 12.
Primary care providers (PCPs) and hospitalists endorse the importance of effective communication yet studies illustrate critical communication problems between these 2 provider types. Our objective was to develop deeper insight into the dimensions of and underlying reasons for communication issues and determine ways to improve communication and remove barriers by eliciting the perspectives of pediatric PCPs and hospitalists.
Using qualitative methods, 2 sets of focus groups were held: 1) mix of local PCPs serving diverse populations, and 2) hospitalists from a free-standing, pediatric institution. The open-ended, semistructured question guides included questions about communication experiences, patient care responsibilities, and suggestions for improvement. Using inductive thematic analysis, investigators coded the transcripts, and resolved differences through consensus.
Six PCP (n = 27) and 3 hospitalist (n = 15) focus groups were held. Fifty-six percent of PCPs and 14% of hospitalists had been practicing for >10 years. Five major themes were identified: problematic aspects of communication, perceptions of provider roles, push-pull, postdischarge responsibilities/care, and proposed solutions. Aspects of communication included specific problem areas with verbal and written communication. Perceptions of provider roles highlighted the issue of PCPs feeling devalued. Push-pull described conflicting expectations about a counterpart's role and responsibilities. Postdischarge responsibilities/care addressed unclear responsibilities related to patient follow-up. Proposed solutions were suggested for ways to improve communication.
Deficiencies in communication hinder successful collaboration and can cause tension between providers in inpatient and outpatient settings. Understanding specific issues that contribute to poor communication like perceptions about provider roles is critical to improving relationships and facilitating combined efforts to improve patient care.
基层医疗服务提供者（PCP）和住院医师都认可有效沟通的重要性，但研究表明这两类医疗服务提供者之间存在严重的沟通问题。我们的目标是更深入地了解沟通问题的维度和潜在原因，并通过征求儿科基层医疗服务提供者和住院医师的意见，确定改善沟通和消除障碍的方法。
采用定性方法，组织了两组焦点小组讨论：1）服务于不同人群的当地基层医疗服务提供者混合组，2）来自一家独立儿科机构的住院医师组。开放式、半结构化问题指南包括有关沟通经历、患者护理职责以及改进建议的问题。研究人员采用归纳主题分析法对转录本进行编码，并通过协商一致解决分歧。
共组织了6个基层医疗服务提供者（n = 27）和3个住院医师（n = 15）焦点小组。56%的基层医疗服务提供者和14%的住院医师从业超过10年。确定了五个主要主题：沟通的问题方面、对医疗服务提供者角色的认知、推拉问题、出院后职责/护理以及提出的解决方案。沟通方面包括口头和书面沟通的具体问题领域。对医疗服务提供者角色的认知突出了基层医疗服务提供者感到自身价值被低估的问题。推拉问题描述了对对方角色和职责的相互矛盾的期望。出院后职责/护理涉及与患者随访相关的职责不明确问题。针对改善沟通的方法提出了建议。
沟通不足阻碍了成功协作，并可能导致住院和门诊环境中医疗服务提供者之间的紧张关系。了解导致沟通不畅的具体问题，如对医疗服务提供者角色的认知，对于改善关系和促进共同努力改善患者护理至关重要。
