Stock Nicola Marie, Anwar Hamza, Sandy Jonathan R, Rumsey Nichola
1 Centre for Appearance Research and The Cleft Collective, University of the West of England, Bristol, UK.
2 Regional Coordinator for the East of England, Cleft Lip and Palate Association, London, UK.
Cleft Palate Craniofac J. 2018 May;55(5):676-681. doi: 10.1177/1055665617744064. Epub 2018 Jan 23.
Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult "returners" who have undergone treatment both pre- and postcentralization.
Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis.
The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients' capacity to cope with the associated emotional challenges.
The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.
自从英国为唇腭裂（CL/P）患者实施集中服务以来，已有多项研究调查了服务合理化对医疗服务提供的影响。虽然大规模定量研究表明一系列患者结局有所改善，小型研究也从卫生专业人员的角度报告了集中化的益处和挑战，但很少有研究试图了解患者的观点。此外，很少有研究调查过在集中化前后都接受过治疗的成年“复诊者”的观点。
与本文主题相关的定性数据取自2013年1月至2014年3月期间进行的2项先前规模更大的研究。共有16名患有唇腭裂的成年人向本研究提供了数据。这些数据进行了归纳主题分析。
研究结果表明，唇腭裂服务的集中化显著提升了患者体验。具体而言，护理的整体标准和协调性得到改善，服务提供变得更加以患者为中心，获得专业心理支持和同伴支持极大地提高了患者应对相关情感挑战的能力。
收集到的数据从一个很大程度上未被探索的患者群体的角度，为集中化的影响提供了更多见解。结合其他文献，这些发现也与全球未来集中其他专科服务的努力相关。
