McKinlay Eileen M, Morgan Sonya J, Gray Ben V, Macdonald Lindsay M, Pullon Susan R H
Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
J Comorb. 2017 Jun 12;7(1):64-78. doi: 10.15256/joc.2017.7.103. eCollection 2017.
The increase in multimorbidity or co-occurring chronic illnesses is a leading healthcare concern. Patients with multimorbidity require ongoing care from many different professionals and agencies, and often report a lack of integrated care.
To explore the daily help-seeking behaviours of patients with multimorbidity, including which health professionals they seek help from, how professionals work together, and perceptions and characteristics of effective interprofessional, interagency multimorbidity care.
Using a case study observational research design, multiple data sources were assembled for four patients with multimorbidity, identified by two general practitioners in New Zealand. In this paper, two case studies are presented, including the recorded instances of contact and communication between patients and professionals, and between professionals. Professional interactions were categorized as consultation, coordination, or collaboration.
The two case studies illustrated two female patients with likely similar educational levels, but with different profiles of multimorbidity, social circumstances, and personal capabilities, involving various professionals and agencies. Engagement between professionals showed varying levels of interaction and a lack of clarity about leadership or care coordination. The majority of interactions were one-to-one consultations and rarely involved coordination and collaboration. Patients were rarely included in communications between professionals.
Cases constructed from multiple data sources illustrate the complexity of day-to-day, interprofessional, interagency multimorbidity care. While consultation is the most frequent mode of professional interaction, targeted coordinated and collaborative interactions (including the patient) are highly effective activities. Greater attention should be given to developing and facilitating these interactions and determining who should lead them.
多种疾病并存或慢性疾病同时发生的情况日益增多，这是医疗保健领域的一个主要关注点。患有多种疾病的患者需要许多不同专业人员和机构提供持续护理，并且经常表示缺乏综合护理。
探讨患有多种疾病的患者的日常求助行为，包括他们向哪些健康专业人员求助、专业人员如何协作，以及有效的跨专业、跨机构的多种疾病护理的认知和特点。
采用案例研究观察性研究设计，为四名患有多种疾病的患者收集了多个数据源，这四名患者由新西兰的两名全科医生确定。本文展示了两个案例研究，包括患者与专业人员之间以及专业人员之间记录的接触和沟通实例。专业互动被分类为咨询、协调或协作。
这两个案例研究展示了两名教育水平可能相似但患有多种疾病的情况、社会环境和个人能力不同的女性患者，涉及各种专业人员和机构。专业人员之间的互动呈现出不同程度的交流，并且在领导或护理协调方面缺乏明确性。大多数互动是一对一的咨询，很少涉及协调和协作。患者很少被纳入专业人员之间的沟通。
从多个数据源构建的案例说明了日常跨专业、跨机构的多种疾病护理的复杂性。虽然咨询是最常见的专业互动模式，但有针对性的协调和协作互动（包括患者）是非常有效的活动。应该更加关注发展和促进这些互动，并确定谁应该领导这些互动。
