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为什么有些医生选择解决医疗保健中的不平等问题?

Why do some physicians choose to tackle inequities in healthcare?

机构信息

Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.

出版信息

Int J Equity Health. 2018 Jun 15;17(1):81. doi: 10.1186/s12939-018-0790-4.

Abstract

BACKGROUND

Despite the reputation of Canada's healthcare system as being accessible to all Canadians, certain populations continue to face inequities within our healthcare system. In addition to promoting fairness, addressing healthcare inequities has the potential to reduce healthcare costs, which is increasingly important as healthcare costs continue to rise. Intentionally or otherwise, physicians are often leaders in healthcare teams, but there is a paucity of literature on physicians' perceptions of the problem of healthcare inequities and their potential role in addressing inequities. In this pilot study, we use a grounded theory approach to explore contextual factors and mechanisms that associate with an individual physician's involvement (or otherwise) in initiatives to reduce healthcare inequity.

METHODS

Using purposeful sampling and a set of a priori questions, we interviewed ten physicians - five of whom self-identified as being actively involved and five not actively involved in addressing healthcare inequities - to explore potential reasons for physicians choosing to address the causes of healthcare inequities.

RESULTS

We identified contextual barriers (e.g., lack of knowledge and time) and facilitators (prior experience, protected time, mentorship and system supports) that we interpreted as interacting with the underlying mechanism (motivation to address inequities) to influence a physician's decision on whether or not to address healthcare inequities.

CONCLUSION

Based upon our findings we propose further studies to understand and/or overcome barriers to physicians being involved in addressing healthcare inequities.

摘要

背景

尽管加拿大的医疗保健系统以向所有加拿大人开放而享有盛誉,但某些人群在我们的医疗保健系统中仍然面临着不平等。除了促进公平之外,解决医疗保健不平等问题还有可能降低医疗保健成本,因为医疗保健成本持续上升,这一点变得越来越重要。有意或无意地,医生通常是医疗团队的领导者,但关于医生对医疗保健不平等问题的看法及其在解决不平等问题中的潜在作用的文献却很少。在这项试点研究中,我们使用扎根理论方法来探讨与个体医生参与(或不参与)减少医疗保健不平等倡议相关的背景因素和机制。

方法

我们使用有目的的抽样和一组预先确定的问题,采访了十名医生 - 其中五名自认为积极参与解决医疗保健不平等问题,五名不积极参与 - 以探讨医生选择解决医疗保健不平等问题的潜在原因。

结果

我们确定了背景障碍(例如,缺乏知识和时间)和促进因素(先前的经验、受保护的时间、指导和系统支持),我们将这些障碍和促进因素解释为与潜在机制(解决不平等问题的动机)相互作用,从而影响医生是否决定解决医疗保健不平等问题。

结论

基于我们的研究结果,我们建议进一步研究以了解和/或克服医生参与解决医疗保健不平等问题的障碍。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92f4/6003020/f605cfbac113/12939_2018_790_Fig1_HTML.jpg

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