Millar Elinor, Stanley James, Gurney Jason, Stairmand Jeannine, Davies Cheryl, Semper Kelly, Dowell Anthony, Lawrenson Ross, Mangin Dee, Sarfati Diana
Cancer and Chronic Conditions (C3) Research Group, University of Otago, Wellington, New Zealand.
Tu Kotahi Asthma Trust, Lower Hutt, New Zealand.
J Prim Health Care. 2018 Mar;10(1):44-53. doi: 10.1071/HC17074.
INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. AIM To understand the experiences of people with multimorbidity in the NZ health care system. METHODS A questionnaire was sent to 758 people with multimorbidity from two primary health care organisations (PHOs). Outcomes were compared to general population estimates from the NZ Health Survey. RESULTS Participants (n = 234, 31% response rate) reported that their general practitioners (GPs) respected their opinions, involved them in decision-making and knew their medical history well. The main barriers to effective care were short GP appointments, availability and affordability of primary and secondary health care, and poor communication between clinicians. Access issues were higher than for the general population. DISCUSSION Participants generally had very positive opinions of primary care and their GP, but encountered structural issues with the health system that created barriers to effective care. These results support the value of ongoing changes to primary care models, with a focus on patient-centred care to address access and care coordination.
引言 多种慢性病共存，即两种或更多种长期疾病同时存在，与生活质量差、医疗保健成本高相关，并加剧了新西兰（NZ）的种族健康不平等。医疗保健服务在很大程度上仍侧重于单一疾病的管理，给患者和临床医生带来了重大挑战。目的 了解新西兰医疗保健系统中患有多种慢性病的人群的经历。方法 向来自两个初级卫生保健组织（PHOs）的758名患有多种慢性病的人发送了问卷。将结果与新西兰健康调查中一般人群的估计数据进行比较。结果 参与者（n = 234，回复率31%）报告称，他们的全科医生（GPs）尊重他们的意见，让他们参与决策，并对他们的病史了如指掌。有效护理的主要障碍是全科医生预约时间短、初级和二级医疗保健的可及性和可负担性，以及临床医生之间沟通不畅。就医问题比一般人群更高。讨论 参与者总体上对初级保健及其全科医生评价很高，但在医疗系统中遇到了结构性问题，这些问题成为有效护理的障碍。这些结果支持了持续改变初级保健模式的价值，重点是以患者为中心的护理，以解决就医和护理协调问题。
