糖尿病患者和医疗服务提供者对澳大利亚创新型糖尿病视网膜病变远程筛查模式有何看法？一项定性研究。

What do patients with diabetes and providers think of an innovative Australian model of remote diabetic retinopathy screening? A qualitative study.

作者信息

Glasson Nicola M, Larkins Sarah L, Crossland Lisa J

机构信息

College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Townsville City, QLD, 4811, Australia.

Discipline of General Practice, University of Queensland, Royal Brisbane Hospital, Level 8 Health Sciences Building, Herston, QLD, 4029, Australia.

出版信息

BMC Health Serv Res. 2017 Feb 22;17(1):158. doi: 10.1186/s12913-017-2045-2.

BACKGROUND

Diabetic retinopathy (DR) is the commonest cause of preventable blindness in working age populations, but up to 98% of visual loss secondary to DR can be prevented with early detection and treatment. In 2012, an innovative outreach DR screening model was implemented in remote communities in a state of Australia. The aim of this study was to explore the acceptability of this unique DR screening model to patients, health professionals and other key stakeholders.

METHODS

This descriptive qualitative study used semi-structured interviews with patients opportunistically recruited whilst attending DR screening, and purposefully selected health care professionals either working within or impacted by the programme. Interviews were audiotaped, transcribed and analysed using NVIVO. An iterative process of thematic analysis was used following the principles of grounded theory.

RESULTS

Interviews were conducted with fourteen patients with diabetes living in three remote communities and nine health professionals or key stakeholders. Nine key themes emerged during interviews with health professionals, key stakeholders and patients: i) improved patient access to DR screening; ii) efficiency, financial implications and sustainability; iii) quality and safety; iv) multi-disciplinary diabetes care; v) training and education; vi) operational elements of service delivery; vii) communication, information sharing and linkages; viii) coordination and integration of the service and ix) suggested improvements to service delivery.

CONCLUSIONS

The Remote Outreach DR Screening Service is highly acceptable to patients and health professionals. Challenges have primarily been encountered in communication and coordination of the service and further development in these areas could improve the programme's impact and sustainability in remote communities. The service is applicable to other remote communities nationally and potentially internationally.

背景

糖尿病视网膜病变（DR）是工作年龄人群可预防失明的最常见原因，但高达98%的因DR导致的视力丧失可通过早期检测和治疗得以预防。2012年，澳大利亚一个州在偏远社区实施了一种创新的外展DR筛查模式。本研究的目的是探讨这种独特的DR筛查模式对患者、卫生专业人员及其他关键利益相关者的可接受性。

方法

这项描述性定性研究采用半结构式访谈，对参加DR筛查时机会性招募的患者，以及特意挑选的在该项目内工作或受该项目影响的卫生保健专业人员进行访谈。访谈进行录音、转录，并使用NVIVO进行分析。遵循扎根理论原则，采用迭代的主题分析过程。

结果

对居住在三个偏远社区的14名糖尿病患者以及9名卫生专业人员或关键利益相关者进行了访谈。在对卫生专业人员、关键利益相关者和患者的访谈中出现了九个关键主题：i）患者更容易获得DR筛查；ii）效率、财务影响和可持续性；iii）质量和安全；iv）多学科糖尿病护理；v）培训和教育；vi）服务提供的操作要素；vii）沟通、信息共享和联系；viii）服务的协调和整合；ix）对服务提供的改进建议。