Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada.
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
BMJ Open. 2019 May 24;9(5):e028344. doi: 10.1136/bmjopen-2018-028344.
There is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs.
Thematic analysis review of the literature.
We developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000-October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Miles.
Twenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills.
This review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.
医疗保健提供者对慢性病和复杂医疗需求患者自我管理特征的了解存在差距。因此，本文的目的是确定慢性病和复杂医疗需求患者的自我管理特征。
文献的主题分析综述。
我们为 MEDLINE 和 CINAHL 数据库制定了搜索策略，涵盖 2000 年 1 月至 2018 年 10 月期间。所有纳入的英文或法文文献均涉及成年患者（18 岁及以上）的自我管理，这些患者具有复杂的医疗需求（多种疾病、脆弱性、复杂性和频繁使用医疗服务）。排除仅涉及单一疾病的自我管理或不具有任何复杂性或脆弱性概念的研究。通过 Miles 描述的三位评估员进行混合主题分析，演绎和归纳。
共纳入 21 篇文章。具有复杂医疗需求的患者具有与自我管理相关的特定特征，这些特征可能因贫困的社会经济条件而加剧。这些患者通常必须根据一种主要疾病来安排护理。他们面临抑郁、心理困扰和自我效能低下的风险，并且可能会从医疗保健提供者那里收到相互矛盾的信息。然而，他们过去在与自身疾病相关的知识和经验可能有助于提高自我管理技能。
该综述确定了慢性病和复杂医疗需求患者自我管理的挑战，这些挑战在社会经济不安全的情况下加剧，并提出了一些策略，以帮助医疗保健提供者更好地调整其自我管理支持干预措施，以满足这一弱势群体的特定需求。
