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健康路径改善医疗服务可及性。

HealthPathways improving access to care.

作者信息

Gill Stephen D, Mansfield Sarah, McLeod Margie, von Treuer Kathryn, Dunn Matthew, Quirk Frances

机构信息

Barwon Health, PO Box 281, Geelong, Vic. 3220, Australia. Email.

School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia. Email.

出版信息

Aust Health Rev. 2019 Apr;43(2):207-216. doi: 10.1071/AH17090.

Abstract

Objective HealthPathways (HPW) is an international web-based information portal that provides health practitioners with guidelines and referral pathways to specialists and services. The present study explored usage of HPW by general practitioners (GPs) in the Barwon region, south-west Victoria, and any benefits and barriers to its use. Methods Approximately 421 GPs provide services in 86 clinics across the Barwon region, south-west Victoria and Barwon Health is the public health service providing acute, subacute, residential aged care and community health services to approximately 350000 people. The present study was a mixed-methods analysis of all GPs in the region, who were invited to complete a survey in two waves (2014 and 2016) and participate in focus groups. Data were survey/questionnaire (fixed response and free text options, analysed with descriptive statistics and content analysis), and focus groups (interview and facilitated group discussion, analysed using the principles of thematic analysis). Results Most GPs surveyed used HPW and usage increased over time from 2014 to 2016 (67% vs 77% respectively). Junior GPs used HPW more often than the more experienced practitioners. GPs reported that HPW was easy to access and navigate, improved their knowledge of local services, improved their confidence, changed their clinical management and saved them time. Main barriers to use of HPW were: GPs did not think to look at HPW, or simply did not know about it. Conclusions HPW has the potential to improve patient management and health outcomes, and use of HPW is increasing over time. What is known about the topic? Initiatives such as HPW are viewed positively by clinicians and have the potential to address challenges at the primary-secondary care interface, specifically, referral to secondary specialists. What does this paper add? Proof of concept that the ongoing availability of localised HPW for common clinical conditions improves GP usage of HPW and has increased access to HPW as the first source of clinical information. Benefits and barriers to use have been identified. What are the implications for practitioners? HPW improves knowledge of local services and provides GPs with easy access to referral pathways.

摘要

目的 健康路径(HPW)是一个基于网络的国际信息门户,为医疗从业者提供指南以及指向专科医生和服务的转诊路径。本研究探讨了维多利亚州西南部巴旺地区的全科医生(GP)对HPW的使用情况,以及使用过程中的任何益处和障碍。方法 约421名全科医生在维多利亚州西南部巴旺地区的86家诊所提供服务,巴旺健康中心是一家公共卫生服务机构,为约35万人提供急性、亚急性、老年住院护理和社区卫生服务。本研究对该地区所有全科医生进行了混合方法分析,邀请他们分两波(2014年和2016年)完成一项调查并参加焦点小组。数据来源为调查/问卷(固定回答和自由文本选项,采用描述性统计和内容分析进行分析)以及焦点小组(访谈和引导式小组讨论,采用主题分析原则进行分析)。结果 大多数接受调查的全科医生使用HPW,且从2014年到2016年使用率随时间上升(分别为67%和77%)。初级全科医生比经验更丰富的从业者更常使用HPW。全科医生报告称,HPW易于访问和导航,提高了他们对当地服务的了解,增强了他们的信心,改变了他们的临床管理方式并节省了时间。使用HPW的主要障碍是:全科医生没想到查看HPW,或者根本不知道它。结论 HPW有改善患者管理和健康结果的潜力,并且随着时间推移对HPW的使用在增加。关于该主题已知的情况是什么?诸如HPW这样的举措受到临床医生的积极评价,并且有潜力应对初级 - 二级护理衔接处的挑战,特别是转诊至二级专科医生的问题。本文补充了什么内容?概念验证表明,针对常见临床病症持续提供本地化的HPW可提高全科医生对HPW的使用,并增加了将HPW作为临床信息首要来源的获取机会。已确定了使用的益处和障碍。对从业者有何影响?HPW提高了对当地服务的了解,并为全科医生提供了便捷的转诊路径。

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