Dobscha Steven K, Cromer Risa, Crain Aysha, Denneson Lauren M
Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Mental Health and Clinical Neurosciences Division, VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA Department of Psychiatry, Oregon Health & Science University, 3181 Sam Jackson Park Rd, Portland, OR 97239, USA.
Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, PO Box 1034 (R&D66), Portland, OR 97207, USA.
Int J Qual Health Care. 2016 Jun;28(3):355-62. doi: 10.1093/intqhc/mzw028. Epub 2016 Mar 29.
Enhanced patient involvement in care has the potential to improve patient experiences and health outcomes. As such, large national and global healthcare systems and organizations, including the US Department of Veterans Affairs (VA), have made patient-centered care a primary goal. Little is known about mental health clinician perspectives on, and experiences with, providing patient-centered care. Our main objective was to better understand VA mental health clinicians' perceptions of patient-centered care, and ascertain possible facilitators and barriers to patient-centered practices in mental health settings.
Qualitative study of six focus groups conducted in late 2013.
Thirty-five mental health clinicians and staff from a large VA Medical Center.
Transcripts were analyzed using an inductive and deductive thematic analysis approach.
Participants described patient-centered care ideally as a process of shared discovery, and expressed general enthusiasm for patient-centered care. Participants described several ongoing patient-centered care practices but conveyed concerns about the practicalities of its full implementation. Participants expressed a strong desire to change the current biomedical culture and policies of the institution that may hinder clinicians' flexibility and clinician-clinician collaboration when serving patients. In particular, clinicians worried about being held responsible for addressing all of the needs or goals that a patient may identify.
If patient-centered care is to be practiced fully in mental health settings, healthcare institutions need to develop multimodal strategies to enhance clinician-clinician and clinician-patient collaborations to promote and support a focus on discovery and shared accountability for outcomes.
加强患者对医疗护理的参与度有可能改善患者体验和健康结局。因此，包括美国退伍军人事务部（VA）在内的大型国家和全球医疗保健系统及组织已将以患者为中心的护理作为首要目标。关于心理健康临床医生对提供以患者为中心护理的看法和经验，我们知之甚少。我们的主要目标是更好地了解VA心理健康临床医生对以患者为中心护理的认知，并确定心理健康环境中以患者为中心实践的可能促进因素和障碍。
2013年末对六个焦点小组进行的定性研究。
来自一家大型VA医疗中心的35名心理健康临床医生和工作人员。
使用归纳和演绎主题分析方法对访谈记录进行分析。
参与者理想地将以患者为中心的护理描述为一个共同探索的过程，并对以患者为中心的护理表达了普遍的热情。参与者描述了几种正在进行的以患者为中心的护理实践，但对其全面实施的实际情况表示担忧。参与者强烈希望改变该机构当前可能会在为患者服务时阻碍临床医生灵活性和临床医生之间协作的生物医学文化和政策。特别是，临床医生担心要对满足患者可能提出的所有需求或目标负责。
如果要在心理健康环境中全面实施以患者为中心的护理，医疗机构需要制定多模式策略，以加强临床医生之间以及临床医生与患者之间的协作，以促进和支持对探索以及对结局的共同责任的关注。
