在德国实施以患者为中心的护理和共同决策的漫长道路。
The long way of implementing patient-centered care and shared decision making in Germany.
作者信息
Härter Martin, Dirmaier Jörg, Scholl Isabelle, Donner-Banzhoff Norbert, Dierks Marie-Luise, Eich Wolfgang, Müller Hardy, Klemperer David, Koch Klaus, Bieber Christiane
机构信息
University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany; Agency for Quality in Medicine (ÄZQ), Berlin, Germany.
University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Hamburg, Germany.
出版信息
Z Evid Fortbild Qual Gesundhwes. 2017 Jun;123-124:46-51. doi: 10.1016/j.zefq.2017.05.006. Epub 2017 May 22.
The main focus of the paper is on the description of the development and current state of research and implementation of patient-centered care (PCC) and shared decision making (SDM) after fifteen years of substantial advances in health policy and health services research. What is the current state of SDM in health policy? The "Patients' Rights Act" from 2013 standardizes all rights and responsibilities within the framework of medical treatment for German citizens and legal residents. This comprises the right to informed decisions, comprehensive and comprehensible information for patients, and decisions based on a clinician-patient-partnership. What is the current state of SDM interventions and patient decision support tools? SDM training programs for healthcare professionals have been developed. Their implementation in medical schools has been successful. Several decision support tools - primarily with support from health insurance funds and other public agencies - are to be implemented in routine care, specifically for national cancer screening programs. What is the current state of research and routine implementation? The German government and other public institutions are constantly funding research programs in which patient-centered care and shared decision-making are important topics. The development and implementation of decision tools for patients and professionals as well as the implementation of CME trainings for healthcare professionals require future efforts. What does the future look like? With the support of health policy and scientific evidence, transfer of PCC and SDM to practice is regarded as meaningful. Research can help to assess barriers, facilitators, and needs, and subsequently to develop and evaluate corresponding strategies to successfully implement PCC and SDM in routine care, which remains challenging.
本文的主要重点是描述在卫生政策和卫生服务研究取得重大进展的十五年后,以患者为中心的护理(PCC)和共同决策(SDM)的发展及当前研究与实施状况。卫生政策中共同决策的当前状况如何?2013年的《患者权利法案》在德国公民和合法居民的医疗框架内规范了所有权利和责任。这包括知情决策的权利、为患者提供全面且易懂的信息,以及基于医患伙伴关系做出的决策。共同决策干预措施和患者决策支持工具的当前状况如何?已经为医疗专业人员制定了共同决策培训计划。这些计划在医学院的实施很成功。一些决策支持工具——主要在健康保险基金和其他公共机构的支持下——将在常规护理中实施,特别是用于国家癌症筛查计划。研究与常规实施的当前状况如何?德国政府和其他公共机构不断为研究项目提供资金,其中以患者为中心的护理和共同决策是重要主题。为患者和专业人员开发及实施决策工具,以及为医疗专业人员实施继续医学教育培训,未来仍需努力。未来会怎样?在卫生政策和科学证据的支持下,将以患者为中心的护理和共同决策转化为实践被认为是有意义的。研究有助于评估障碍、促进因素和需求,随后制定和评估相应策略,以便在常规护理中成功实施以患者为中心的护理和共同决策,这仍然具有挑战性。