Lai Yi Feng, Lum Andrew Yew Wai, Ho Emily Tse Lin, Lim Yee Wei
Department of Pharmacy, Sengkang Health, Singapore, Singapore.
Department of Pharmacy, Raffles Hospital, Singapore, Singapore.
PLoS One. 2017 Oct 27;12(10):e0187372. doi: 10.1371/journal.pone.0187372. eCollection 2017.
Integrated care has been well-recognized as a solution to improve quality of care for patients with complex needs. As Singapore increasingly develops and promotes integrated models of care, it is unclear if providers, patients, and caregivers share similar understanding of changes in the healthcare system.
This study aims at exploring three dimensions of care integration: a) understanding of integration; b) challenges and c) changes perceived as essential among three distinct stakeholder groups: providers, patients and caregivers.
This qualitative study was conducted among 41 care providers (clinicians and administrators) and care consumers (patients and caregivers) in Singapore utilizing 29 semi-structured interviews and 2 focus group discussions. Study participants were selected by purposive, snowball sampling from various clinical settings. Data were transcribed, familiarized, coded and analyzed using a conceptual framework.
Understanding of care integration was generally lacking among patient and caregivers. Most of them focused on healthcare costs and accessibility of services. Providers characterized care integration in clinical process terms and had a more systems view of the concept. Most participants viewed resource constraints as a key challenge in integrating care. Additionally, providers expressed the need for patients and their families to play a greater role in managing their health. Individuals and the community are key components of an integrated care system in the future. Reliance on the healthcare system alone is not sustainable.
Patients, caregivers and providers have varying degrees of understanding towards care integration. The success of engaging stakeholders on the ground to be active participants in the healthcare system integration process requires policymakers and healthcare leaders to increase patient engagement efforts and to better appreciate the challenges faced by the healthcare workers in the rapidly changing national and global healthcare landscape.
整合照护已被公认为是改善有复杂需求患者照护质量的一种解决方案。随着新加坡日益发展并推广整合照护模式，尚不清楚提供者、患者及照护者对医疗系统变化是否有相似的理解。
本研究旨在探索照护整合的三个维度：a）对照护整合的理解；b）挑战；以及c）三个不同利益相关者群体（提供者、患者和照护者）认为至关重要的变化。
本定性研究在新加坡的41名照护提供者（临床医生和管理人员）以及照护消费者（患者和照护者）中进行，采用了29次半结构化访谈和2次焦点小组讨论。研究参与者通过目的抽样和滚雪球抽样从各种临床环境中选取。数据进行转录、熟悉、编码并使用概念框架进行分析。
患者和照护者普遍缺乏对照护整合的理解。他们大多关注医疗费用和服务可及性。提供者从临床过程角度描述照护整合，对该概念有更系统的看法。大多数参与者将资源限制视为整合照护的关键挑战。此外，提供者表示患者及其家人需要在管理自身健康方面发挥更大作用。个人和社区是未来整合照护系统的关键组成部分。仅依赖医疗系统是不可持续的。
患者、照护者和提供者对照护整合的理解程度各不相同。要让实地的利益相关者成为医疗系统整合过程中的积极参与者，政策制定者和医疗领导者需要加大患者参与力度，并更好地认识到在快速变化的国家和全球医疗环境中医疗工作者所面临的挑战。
