慢性心力衰竭护理从医院向全科医疗的转变：患者视角
Substitution of care for chronic heart failure from the hospital to the general practice: patients' perspectives.
作者信息
Wildeboer J A, van de Ven A R T, de Boer D
机构信息
VU University Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, Netherlands.
St. Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, Netherlands.
出版信息
BMC Fam Pract. 2018 Jan 9;19(1):8. doi: 10.1186/s12875-017-0688-z.
BACKGROUND
Shifting care from the secondary to the primary system may present an opportunity to ensure that the increasing number of patients with chronic heart failure (CHF) receive high-quality care while containing costs. However, shifting from secondary to primary care might seem radical to patients. A qualitative insight into patients' issues, preferences, expectations and needs may help arrange a smooth transition from secondary to primary care for CHF patients. The aim of this exploratory study is therefore to gain insights into the way CHF patients in secondary care perceive the possibility of substitution of CHF care from secondary to primary care.
METHODS
In total, fifteen semi-structured interviews were conducted with CHF patients. Topics discussed during the interviews were the advantages and disadvantages, attitudes of patients, preferences regarding the substitution and trust in the GP and cardiologist. A thematic analysis was performed.
RESULTS
The minority of the patients welcomed the idea of substitution. Against that, the majority of the patients had various concerns. This attitude was mainly influenced by two main themes, confidence and security and accessibility. Most patients had more confidence in secondary than in primary care because of the greater level of knowledge and more possibilities for examination in secondary care and because of good relationships and positive previous experiences in secondary care. Patients also indicated that the general practice is geographically more easily accessible than the hospital.
CONCLUSION
Patients had various concerns regarding the substitution of care for chronic heart failure. Addressing these concerns by informing them appropriately may contribute to a smooth and patient-friendly substitution from secondary to primary care. The fears and needs of patients could also be taken into account by policymakers when optimising the way substitution is organised, or when substitution is introduced.
背景
将护理从二级医疗体系转移至初级医疗体系，可能为确保越来越多的慢性心力衰竭（CHF）患者在控制成本的同时获得高质量护理提供契机。然而，对患者而言，从二级医疗转向初级医疗似乎过于激进。对患者的问题、偏好、期望和需求进行定性洞察，可能有助于为CHF患者安排从二级医疗到初级医疗的平稳过渡。因此，本探索性研究的目的是深入了解二级医疗中的CHF患者如何看待CHF护理从二级医疗向初级医疗替代的可能性。
方法
总共对CHF患者进行了15次半结构化访谈。访谈中讨论的主题包括替代的优缺点、患者的态度、对替代的偏好以及对全科医生和心脏病专家的信任。进行了主题分析。
结果
少数患者欢迎替代的想法。与此相反，大多数患者有各种担忧。这种态度主要受两个主要主题影响，即信心与安全感以及可及性。由于二级医疗中知识水平更高、检查可能性更多，以及在二级医疗中有良好的关系和积极的既往经历，大多数患者对二级医疗的信心高于初级医疗。患者还表示，全科诊所相比医院在地理位置上更容易到达。
结论
患者对慢性心力衰竭护理替代存在各种担忧。通过适当地告知他们来解决这些担忧，可能有助于实现从二级医疗到初级医疗的平稳且对患者友好的替代。政策制定者在优化替代安排方式或引入替代措施时，也可以考虑患者的恐惧和需求。
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