NIHR School for Primary Care Research, University of Manchester, Manchester, UK.
Department of Health Sciences, University of York, York, UK.
Health Expect. 2018 Dec;21(6):1066-1074. doi: 10.1111/hex.12803. Epub 2018 Jul 13.
Person-centredness is important in delivering care for long-term conditions. New models of care aim to co-ordinate care through integration of health and social care which require new ways of working, often remotely from the patient.
To describe how person-centred care is enacted within multidisciplinary groups (MDGs) created as part of a new service, integrating health and social care for older people.
We followed the implementation of eight neighbourhood MDGs, observing and interviewing staff from three MDGs at different phases of programme implementation using semi-structured topic guides.
Thirty-four MDG meetings were observed and 32 staff interviewed. Three core themes were identified which impacted on enactment of person-centred care: the structural context of MDGs enabling person-centred care; interaction of staff and knowledge sharing during the MDG meetings; and direct staff involvement of the person outside the MDG discussion.
This study provides new insights into attempts to enact person-centred care within a new model of service delivery. Teams did what they could to enact person-centred care in the absence of the "real" patient within MDG meetings. They were successful in delivering and co-ordinating some aspects of care (eg prompting medication reviews, referring to social worker, health improvement and arranging further multidisciplinary team meetings for complex cases). This "absence of patients" and time pressures within the MDGs led to reliance on the "virtual" record, enhanced by additional "soft" knowledge provided by staff, rather than ensuring the patient's voice was included.
以患者为中心是提供长期护理的关键。新的护理模式旨在通过整合卫生和社会保健来协调护理，这需要新的工作方式，通常是远程为患者提供服务。
描述以患者为中心的护理如何在作为新服务一部分创建的多学科小组 (MDG) 中实施，该服务整合了老年人的卫生和社会保健。
我们跟踪了 8 个邻里 MDG 的实施情况，使用半结构化主题指南观察和采访了来自 3 个 MDG 的不同阶段的工作人员。
观察了 34 次 MDG 会议并采访了 32 名员工。确定了三个核心主题，这些主题影响了以患者为中心的护理的实施：MDG 能够实现以患者为中心的护理的结构性背景；MDG 会议期间工作人员的互动和知识共享；以及工作人员在 MDG 讨论之外直接参与患者。
这项研究提供了关于在新的服务交付模式中实施以患者为中心的护理的新见解。团队在 MDG 会议中没有“真实”患者的情况下尽力实施以患者为中心的护理。他们在提供和协调某些方面的护理方面取得了成功（例如提示药物审查、转介给社会工作者、促进健康改善和为复杂病例安排进一步的多学科团队会议）。MDG 中的“患者缺席”和时间压力导致依赖“虚拟”记录，通过工作人员提供的额外“软性”知识加以增强，而不是确保患者的声音被包括在内。
