Kim Bo, Miller Christopher J, Elwy A Rani, Holmes Sally K, Coldwell Craig M, Bauer Mark S
a VA Health Services Research & Development Center for Healthcare Organization and Implementation Research , Boston , Massachusetts , USA.
b Harvard Medical School , Boston , Massachusetts , USA.
J Interprof Care. 2017 May;31(3):360-367. doi: 10.1080/13561820.2017.1283302. Epub 2017 Mar 1.
The US Veterans Health Administration (VHA) in 2013 mandated a nationwide implementation of interprofessional team-based care in the general mental health setting and officially endorsed the collaborative care model in 2015 to guide the coordinated and anticipatory care to be delivered by these teams. Front-line clinic staff are major stakeholders whose practices are most directly affected by this implementation and may or may not view teams as useful or feasible for their practice. Our objective was to examine their perspectives on delivering team-to-patient care in order to understand what system-level efforts can best support the transition to such care from the more conventional provider-to-patient care. We conducted 14 semi-structured interviews with staff from general mental health clinics across three different VHA medical facilities. The interview questions focused on asking how care is organised and delivered at their clinic, their experiences in collaborating with other staff, and how the clinic handles changes. Four recurrent themes were identified: navigating workplace supervision, organisation, and role structures; continuing professional growth and relationships; delivering patient-focused care through education and connection to resources; and utilising information technology for communication and panel-based management. Quality improvement efforts were rarely discussed during the interviews. Our results indicate that staff's endorsement of the implementation of interprofessional care teams in general mental health settings may be strengthened through associated efforts targeted at enhancing their experiences aligned to these emergent themes.
2013年,美国退伍军人健康管理局(VHA)要求在全国范围内的普通心理健康服务中实施跨专业团队式护理,并于2015年正式认可协作护理模式,以指导这些团队提供协调和预期性护理。一线诊所工作人员是主要利益相关者,其工作实践最直接受到这一实施举措的影响,他们可能认为团队对其工作有用,也可能不这么认为。我们的目标是研究他们对提供团队对患者护理的看法,以便了解哪些系统层面的努力能够最好地支持从更传统的提供者对患者护理向这种护理的转变。我们对来自三个不同VHA医疗设施的普通心理健康诊所的工作人员进行了14次半结构化访谈。访谈问题集中在询问他们诊所的护理是如何组织和提供的、他们与其他工作人员协作的经验,以及诊所如何应对变化。确定了四个反复出现的主题:应对工作场所的监督、组织和角色结构;持续的职业发展和人际关系;通过教育和与资源的联系提供以患者为中心的护理;以及利用信息技术进行沟通和基于小组的管理。访谈中很少讨论质量改进工作。我们的结果表明,通过针对增强他们与这些新出现主题相关的经验的相关努力,可能会加强工作人员对在普通心理健康环境中实施跨专业护理团队的认可。