Ploeg Jenny, Denton Margaret, Hutchison Brian, McAiney Carrie, Moore Ainsley, Brazil Kevin, Tindale Joseph, Lam Annie
Professor in the School of Nursing in the Faculty of Health Sciences and an associate member of the Department of Health, Aging and Society at McMaster University in Hamilton, Ont, and Scientific Director of the Aging, Community and Health Research Unit.
Professor Emeritus in the Department of Health, Aging and Society and the Department of Sociology at McMaster University.
Can Fam Physician. 2017 Jan;63(1):e31-e42.
To understand how family physicians facilitate older patients' access to community support services (CSSs) and to identify similarities and differences across primary health care (PHC) models.
Qualitative, multiple-case study design using semistructured interviews.
Four models of PHC delivery, specifically 2 family health teams (FHTs), 4 non-FHTs family health organizations, 4 fee-for-service practices, and 2 community health centres in urban Ontario.
Purposeful sampling of 23 family physicians in solo and small and large group practices within the 4 models of PHC.
A multiple-case study approach was used. Semistructured interviews were conducted and data were analyzed using within- and cross-case analysis. Case study tactics to ensure study rigour included memos and an audit trail, investigator triangulation, and the use of multiple, rather than single, case studies.
Three main themes were identified: consulting and communicating with the health care team to create linkages; linking patients and families to CSSs; and relying on out-of-date resources and ineffective search strategies for information on CSSs. All participants worked with their team members; however, those in FHTs and community health centres generally had a broader range of health care providers available to assist them. Physicians relied on home-care case managers to help make linkages to CSSs. Physicians recommended the development of an easily searchable, online database containing available CSSs.
This study shows the importance of interprofessional teamwork in primary care settings to facilitate linkages of older patients to CSSs. The study also provides insight into the strategies physicians use to link older persons to CSSs and their recommendations for change. This understanding can be used to develop resources and approaches to better support physicians in making appropriate linkages to CSSs.
了解家庭医生如何协助老年患者获得社区支持服务（CSSs），并确定初级卫生保健（PHC）模式之间的异同。
采用半结构式访谈的定性多案例研究设计。
四种初级卫生保健服务提供模式，具体为安大略省城市地区的2个家庭健康团队（FHTs）、4个非FHTs家庭健康组织、4个按服务收费的诊所和2个社区卫生中心。
在4种初级卫生保健模式下，对23名个体执业以及小型和大型团体执业的家庭医生进行目的抽样。
采用多案例研究方法。进行半结构式访谈，并使用案例内和跨案例分析对数据进行分析。确保研究严谨性的案例研究策略包括备忘录和审计追踪、研究者三角互证，以及使用多个而非单个案例研究。
确定了三个主要主题：与医疗团队咨询和沟通以建立联系；将患者及其家庭与社区支持服务联系起来；依靠过时的资源和无效的搜索策略获取社区支持服务信息。所有参与者都与团队成员合作；然而，家庭健康团队和社区卫生中心的参与者通常有更广泛的医疗服务提供者可协助他们。医生依靠家庭护理个案经理来帮助与社区支持服务建立联系。医生建议开发一个易于搜索的在线数据库，其中包含可用的社区支持服务。
本研究表明了初级保健环境中跨专业团队合作对于促进老年患者与社区支持服务建立联系的重要性。该研究还深入了解了医生将老年人与社区支持服务联系起来所使用的策略以及他们对变革的建议。这种理解可用于开发资源和方法，以更好地支持医生与社区支持服务建立适当联系。
