Mastebroek Mathilde, Naaldenberg Jenneken, van den Driessen Mareeuw Francine A, Lagro-Janssen Antoine L M, van Schrojenstein Lantman-de Valk Henny M J
Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands.
Fam Pract. 2016 Oct;33(5):543-50. doi: 10.1093/fampra/cmw057. Epub 2016 Jul 12.
Accurate health information exchange (HIE) is pivotal for good quality of care. However, patients with intellectual disabilities (ID) face challenges in processing and exchanging health information around GP consultations. Knowledge of HIE barriers and facilitators, including the roles of carers, may help to improve GP care for people with ID.
To gain more insight into HIE barriers and facilitators for ID patients in GP care.
A qualitative study exploring GP consultation experiences of people with ID (n = 35), professional carers (n = 20) and relatives (n = 15). Transcripts from interviews and focus groups were analyzed using a framework analysis approach.
Analyses resulted in four themes: (i) Recognizing patient health needs; (ii) Impaired doctor-patient communication; (iii) Carers' mediating roles during consultations; and (iv) Patients' autonomy and self-determination. Barriers related to communication skills, lack of time, continuity of carers and physicians, information alignment between relative or professional carer and the GP, and information transfer and recording within the patient network. Facilitating factors related mainly to carer interventions, personal connections with patients and GP communication with patients and carers outside the consultation.
There is considerable HIE potential in patients themselves, as well as in their network, although many barriers have to be overcome to profit from this. GP practices are recommended to adjust consultations and communication practices and to facilitate deployment of the patient's network, while still considering patient autonomy.
准确的健康信息交换（HIE）对于高质量医疗至关重要。然而，智障患者在围绕全科医生会诊处理和交换健康信息方面面临挑战。了解HIE的障碍和促进因素，包括照顾者的作用，可能有助于改善全科医生对智障患者的护理。
更深入地了解全科医疗中智障患者的HIE障碍和促进因素。
一项定性研究，探讨了35名智障患者、20名专业照顾者和15名亲属的全科医生会诊经历。采用框架分析方法对访谈和焦点小组的记录进行分析。
分析得出四个主题：（i）识别患者的健康需求；（ii）医患沟通受损；（iii）照顾者在会诊期间的调解作用；（iv）患者的自主性和自决权。障碍涉及沟通技巧、时间不足、照顾者和医生的连续性、亲属或专业照顾者与全科医生之间的信息一致性，以及患者网络内的信息传递和记录。促进因素主要与照顾者的干预、与患者的个人联系以及全科医生在会诊之外与患者和照顾者沟通有关。
患者自身及其网络中存在相当大的HIE潜力，尽管要从中受益还需克服许多障碍。建议全科医疗实践调整会诊和沟通方式，促进患者网络的部署，同时仍要考虑患者的自主性。
