Brown Judith Belle, Ryan Bridget L, Thorpe Cathy
Departments of Family Medicine (Brown, Ryan, Thorpe), and Epidemiology and Biostatistics (Ryan), Schulich School of Medicine and Dentistry, Western University; School of Social Work (Brown), King's University College, Western University, London, Ont.
CMAJ Open. 2016 Jun 1;4(2):E271-6. doi: 10.9778/cmajo.20150128. eCollection 2016 Apr-Jun.
Patient-centred care, access to care, and continuity of and coordination of care are core processes in primary health care delivery. Our objective was to evaluate how these processes are enacted by 1 primary care model, Family Health Teams, in Ontario.
Our study used grounded theory methodology to examine these 4 processes of care from the perspective of health care providers. Twenty Family Health Team practice sites in Ontario were selected to represent maximum variation (e.g., location, year of Family Health Team approval). Semi-structured interviews were conducted with each participant. A constant comparative approach was used to analyze the data.
Our final sample population involved 110 participants from 20 Family Health Teams. Participants described how their Family Health Team strived to provide patient-centred care, to ensure access, and to pursue continuity and coordination in their delivery of care. Patient-centred care was provided through a variety of means forging the links among the other processes of care. Participants from all teams articulated a commitment to timely access, spontaneously expressing the importance of access to mental health services. Continuity of care was linked to both access and patient-centred care. Coordination of care by the team was perceived to reduce unnecessary walk-in clinic and emergency department visits, and facilitated a smoother transition from hospital to home.
These 4 processes of patient care were inextricably linked. Patient-centred care was the focal point, and these processes in turn served to enhance the delivery of patient-centred care.
以患者为中心的医疗服务、医疗服务可及性以及医疗服务的连续性与协调性是初级卫生保健服务提供中的核心流程。我们的目标是评估安大略省的一种初级保健模式——家庭健康团队是如何落实这些流程的。
我们的研究采用扎根理论方法，从医疗服务提供者的角度审视这4个医疗服务流程。选取了安大略省20个家庭健康团队的执业地点，以体现最大程度的差异（例如，地点、家庭健康团队获批年份）。对每位参与者进行了半结构化访谈。采用持续比较法分析数据。
我们的最终样本群体包括来自20个家庭健康团队的110名参与者。参与者描述了他们的家庭健康团队如何努力提供以患者为中心的医疗服务，确保医疗服务可及性，并在提供医疗服务时追求连续性与协调性。通过多种方式提供以患者为中心的医疗服务，从而在其他医疗服务流程之间建立联系。所有团队的参与者都明确表示致力于提供及时的医疗服务，自发表达了获得心理健康服务的重要性。医疗服务的连续性与医疗服务可及性以及以患者为中心的医疗服务都有关联。团队的医疗服务协调性被认为减少了不必要的门诊和急诊科就诊，并促进了从医院到家庭的更平稳过渡。
这4个患者医疗服务流程紧密相连。以患者为中心的医疗服务是重点，而这些流程反过来又有助于加强以患者为中心的医疗服务的提供。
