Sampson Rod, Barbour Rosaline, Wilson Philip
Cairn Medical Practice, 15 Culduthel Road, Inverness, IV2 4AG, Scotland.
The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, England.
BMC Fam Pract. 2016 Apr 14;17:45. doi: 10.1186/s12875-016-0442-y.
Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care.
A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory.
Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve).
The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.
提高基层医疗与二级医疗衔接处的医疗服务质量是一个全国性乃至更广泛的关注点。在对临床医生在该衔接处关系的定性探索中，我们希望研究全科医生（GP）和医院专科医生如何看待彼此以及如何相互对待，以及这可能如何影响患者护理。
在苏格兰高地国民保健服务（NHS）卫生委员会地区的基层和二级医疗中心开展了一项定性访谈研究。邀请符合条件的临床医生（全科医生和医院专科医生）参加半结构化访谈，以探讨衔接处关系对患者护理的影响。采用了标准的主题分析法，包括基于扎根理论的迭代过程。
临床医生出现的关键主题包括沟通（相互联系和倾听以及软信息传递的重要性）、行为（指在衔接处察觉到的不适当工作量转移以及对此转移的抵制）、关系（衔接处临床医生之间以及临床医生与患者之间的关系）和不切实际的期望（临床医生对另一衔接处同事所能取得成果表达的理想主义期望）。
基层医疗和二级医疗临床医生之间的关系，尤其是困难和误解，可能会对患者护理产生影响。解决研究中确定的关键领域可能有助于改善衔接处关系并使患者护理受益。
