Johannes Bobbie, Graaf Deanna, Blatt Barbara, George Daniel, Gonzalo Jed D
Research Assistant, Department of Health Policy and Administration, Pennsylvania State University, University Park, PA, USA.
Patient Navigation Coordinator, Office of Medical Education, Penn State College of Medicine, Hershey, PA, USA.
Prim Health Care Res Dev. 2018 Jun 28;20:e61. doi: 10.1017/S1463423618000385.
To investigate which populations of patients are considered 'vulnerable' across varying clinical sites, and to identify the barriers encountered by these patient populations limiting optimal health.
Vulnerable patient populations encounter diverse barriers that limit their ability to successfully navigate the health system, potentially resulting in poor health outcomes. Little current-day work has described types of barriers encountered by vulnerable patient populations across numerous clinical sites and settings, which is necessary to ensure health systems can begin to improve quality and disparities for all patient populations.
An inductive content analysis was performed based on field-site notes and digitally recorded telephone interviews with providers/leadership at clinics/programs related to patient- and clinic-needs from January 2014 through May 2015. Using thematic analysis with grounded theory techniques, authors identified categories and themes. In total, 30 diverse clinical sites/programs including inpatient- and outpatient-based clinics providing medicine and surgery-based services were assessed through both site visits and follow-up telephone interviews. Follow-up interviews were conducted with one individual in various positions within sites/programs, including physicians (n=15), registered nurses (n=8), clinic managers/coordinators (n=2), clinical program coordinator (n=1), and care coordinator (n=1); one participant represented three clinical sites.
In total, 30 sites/programs (n=30) received both a site visit and follow-up interview. Commonly reported vulnerable patient populations included those with multiple chronic conditions, lower socioeconomic status, patients in a specific stage in the continuum of care, and patients with over- and under-utilization of resources without a clear etiology. Themes related to barriers included systems barriers (eg, insufficiencies of care processes), clinic barriers (eg, lack of resources), patient-related barriers (eg, housing, transportation), and provider-related barriers (eg, inadequate time and knowledge).
These results provide a framework to identify systems- and clinic-related barriers that can be used in population health management strategies aimed at improving health disparities within clinically diverse sites.
调查在不同临床场所中哪些患者群体被视为“弱势群体”，并确定这些患者群体在实现最佳健康方面所面临的障碍。
弱势群体在医疗系统中面临各种障碍，这些障碍限制了他们成功应对医疗系统的能力，可能导致不良的健康结果。目前很少有研究描述弱势群体在众多临床场所和环境中遇到的障碍类型，而这对于确保医疗系统能够开始改善所有患者群体的医疗质量和差异至关重要。
基于2014年1月至2015年5月期间与各诊所/项目中与患者及诊所需求相关的提供者/负责人进行的实地记录和电话录音访谈，进行归纳性内容分析。作者运用基于扎根理论技术的主题分析法确定类别和主题。通过实地考察和后续电话访谈，共评估了30个不同的临床场所/项目，包括提供药物和外科手术服务的住院和门诊诊所。对各场所/项目中不同职位的人员进行了后续访谈，包括医生（n = 15）、注册护士（n = 8）、诊所经理/协调员（n = 2）、临床项目协调员（n = 1）和护理协调员（n = 1）；一名参与者代表三个临床场所。
共有30个场所/项目（n = 30）接受了实地考察和后续访谈。常见的弱势群体包括患有多种慢性病的患者、社会经济地位较低的患者、处于连续护理特定阶段的患者，以及资源利用过度和不足且病因不明的患者。与障碍相关的主题包括系统障碍（如护理流程不足）、诊所障碍（如资源缺乏）、患者相关障碍（如住房、交通）和提供者相关障碍（如时间和知识不足）。
这些结果提供了一个框架，用于识别与系统和诊所相关的障碍，这些障碍可用于旨在改善不同临床场所健康差异的人群健康管理策略。
