Pratt Rebekah, Hibberd Carina, Cameron Isobel M, Maxwell Margaret
Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN, USA.
School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK.
J Comorb. 2015 Jul 16;5:110-119. doi: 10.15256/joc.2015.5.35. eCollection 2015.
Social dimensions of health are known to contribute to what is often termed "patient complexity," which is particularly common among patients with multimorbidity. Health-care professionals require tools to help them identify and manage these aspects of patient needs.
To examine: (i) the Patient Centered Assessment Method (PCAM), a tool for assessing patient complexity in ways that are sensitive to the biopsychosocial dimensions of health, in primary care settings in Scotland; (ii) the impact of the PCAM on referral patterns and its perceived value; and (iii) the PCAM's perceived applicability for use in a complex patient population.
Two studies are described: (i) a mixed-methods prospective cohort study of the implementation of the PCAM in primary care clinics; and (ii) a qualitative exploratory study that evaluated the value of the PCAM in a complex patient population.
Use of the PCAM did not impact patient satisfaction or perception of practitioners' empathy, but it did increase both the number of onward referrals per referred patient (9-12%) and the proportion of referrals to non-medical services addressing psychological, social, and lifestyle needs. Nurses valued the PCAM, particularly its ability to help them address psychological and social domains of patients' lives, and found it to be highly relevant for use in populations with known high complexity.
The PCAM represents a feasible approach for assessing patient needs with consideration to the social dimensions of health, and allows practitioners to refer patients to a broader range of services to address patient complexity.
健康的社会维度被认为是导致通常所说的“患者复杂性”的因素之一，这在患有多种疾病的患者中尤为常见。医疗保健专业人员需要工具来帮助他们识别和管理患者需求的这些方面。
研究：（i）以对健康的生物心理社会维度敏感的方式评估患者复杂性的工具——以患者为中心的评估方法（PCAM）在苏格兰初级保健机构中的应用；（ii）PCAM对转诊模式的影响及其感知价值；（iii）PCAM在复杂患者群体中的感知适用性。
描述了两项研究：（i）在初级保健诊所实施PCAM的混合方法前瞻性队列研究；（ii）评估PCAM在复杂患者群体中的价值的定性探索性研究。
使用PCAM并未影响患者满意度或对从业者同理心的感知，但确实增加了每位转诊患者的后续转诊数量（9%-12%）以及转诊至满足心理、社会和生活方式需求的非医疗服务的比例。护士重视PCAM，特别是其帮助他们处理患者生活中的心理和社会领域问题的能力，并发现它在已知复杂性高的人群中非常适用。
PCAM是一种在考虑健康社会维度的情况下评估患者需求的可行方法，使从业者能够将患者转诊至更广泛的服务以应对患者复杂性。
