Chen Jingwen Jessica, Gamble Kathryn, Graham-Wisener Lisa, McGlade Kieran, Doherty Jennifer, Donnelly Patrick, Stone Carol A
Queen's University Belfast, Belfast, UK.
Marie Curie Hospice Belfast, Belfast, UK.
Open Heart. 2018 Apr 5;5(1):e000734. doi: 10.1136/openhrt-2017-000734. eCollection 2018.
To assess the adequacy of community-based services available in Northern Ireland (NI) and to meet the multidimensional needs of patients living with New York Heart Association Stage III and IV heart failure (HF), as experienced and perceived by general practitioners (GP).
Semistructured interviews were conducted with GPs recruited via the University Department of General Practice and Northern Ireland Medical and Dental Agency. Interviews were transcribed, independently coded and analysed using a six-step thematic analysis approach.
Twenty semistructured interviews were conducted. GPs reported managing patients in a 'reactive rather than proactive' way, responding only to acute medical needs, with hospital admission the default option due to lack of community-based expertise and services. Care provided by HF specialists was highly regarded but 'access and coordination' were lacking, related to inequity of access to Heart Failure Nursing Teams, lack of access to specialist advice and inadequate handover of information to GPs. Conversations regarding current and future care needs and preferences were important, but GPs described 'neglecting conversations with the patient', due to time constraints, prognostic uncertainty and fear of causing distress. They expressed the view that 'specialist palliative care (SPC) is only a credible option in end stages' related to limited understanding of the scope of SPC, a perception that timing of referral must depend on prognosis and concern that SPC services are cancer-focused.
Despite the extensive body of research which evidences the unmet multidimensional needs of patients with advanced HF, and more recent evidence for the effectiveness of integrated SPC in improving quality of life for patients with HF, health and social care services within NI have not adapted to assess and meet these needs.
评估北爱尔兰现有的社区服务是否充足，以满足纽约心脏协会III期和IV期心力衰竭（HF）患者的多维度需求，这是全科医生（GP）所经历和感知到的。
通过全科医学大学系和北爱尔兰医学与牙科机构招募全科医生进行半结构化访谈。访谈内容被转录，使用六步主题分析方法进行独立编码和分析。
进行了20次半结构化访谈。全科医生报告以“被动而非主动”的方式管理患者，仅对急性医疗需求做出反应，由于缺乏社区专业知识和服务，默认选择住院治疗。心力衰竭专科医生提供的护理受到高度评价，但存在“获取和协调”方面的问题，这与获取心力衰竭护理团队的不平等、缺乏获取专科建议的途径以及向全科医生的信息交接不充分有关。关于当前和未来护理需求及偏好的对话很重要，但全科医生表示由于时间限制、预后不确定性和担心造成困扰，“忽视了与患者的对话”。他们认为“专科姑息治疗（SPC）仅在末期才是可靠的选择”，这与对SPC范围的理解有限、认为转诊时机必须取决于预后以及担心SPC服务以癌症为重点有关。
尽管有大量研究证明晚期心力衰竭患者的多维度需求未得到满足，且近期有证据表明综合SPC对改善心力衰竭患者生活质量有效，但北爱尔兰的卫生和社会护理服务尚未做出调整以评估和满足这些需求。
