Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada.
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Health Soc Care Community. 2019 Jul;27(4):e522-e533. doi: 10.1111/hsc.12751. Epub 2019 Apr 11.
Given limited available geriatric specialists and complexity of dementia care, there is a need for greater collaboration between primary care and specialists to better meet the needs of persons with dementia. Meaningful family physician-specialist collaboration has the potential to improve health outcomes, timely access to care and more appropriate healthcare resource utilisation. Primary Care Collaborative Memory Clinics (PCCMCs), which include specialist support, provide a significant opportunity for studying the family physician-specialist interface. This study aimed to explore the nature of collaborative relationships between memory clinic family physicians and specialists caring for persons with memory concerns in PCCMCs across Ontario, Canada. Family physicians (N = 71) attending an education session and specialists (N = 21) completed a survey in the fall of 2017 that measured frequency and amount of collaboration, perceptions of their relationship and identified factors that enable and challenge collaboration. Descriptive statistics were generated for quantitative data and themes for responses to open-ended questions were explored using descriptive qualitative content analysis. Specialists and memory clinic family physicians valued their collaboration particularly as related to capacity building for dementia care and desired more time devoted to collaboration. Identified enablers and barriers to collaboration have implications for further integration of specialist support to potentially support improved patient care and further build capacity in primary care to manage dementia care. Opportunities exist for expanding and more intentionally supporting how family physicians and specialists interact with the creation of more formalised processes to support optimal collaboration, including a clear delineation of roles, responsibilities and expectations, more formally planned and structured relationship building and monitoring, identifying and addressing unique barriers to collaboration and use of a variety of methods of communication. Study findings have implications for how specialists and family physicians communicate and collaborate in other programmes for complex chronic conditions.
鉴于老年病专家有限且痴呆症护理复杂,初级保健医生和专家之间需要加强合作,以更好地满足痴呆症患者的需求。有意义的家庭医生-专家合作有可能改善健康结果、及时获得护理以及更合理地利用医疗资源。包括专家支持在内的初级保健合作记忆诊所(PCCMC)为研究家庭医生-专家之间的接口提供了重要机会。本研究旨在探索安大略省 PCCMC 中照顾有记忆问题的患者的记忆诊所家庭医生和专家之间合作关系的性质。参加教育课程的家庭医生(N=71)和专家(N=21)在 2017 年秋季完成了一项调查,该调查衡量了合作的频率和数量、对他们关系的看法以及确定了促进和挑战合作的因素。对定量数据进行了描述性统计,对开放式问题的回答进行了主题探索,使用描述性定性内容分析。专家和记忆诊所家庭医生特别重视他们的合作,尤其是在建立痴呆症护理能力方面,并希望投入更多时间进行合作。确定的合作促成因素和障碍对进一步整合专家支持具有影响,以支持改善患者护理并进一步建立初级保健管理痴呆症护理的能力。有机会扩大和更有针对性地支持家庭医生和专家之间的互动方式,创建更正式的流程以支持最佳合作,包括明确划分角色、责任和期望,更有计划和结构化的关系建立和监测,识别和解决合作的独特障碍,以及使用各种沟通方法。研究结果对专家和家庭医生在其他复杂慢性病计划中的沟通和合作方式具有影响。
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