全科医生技能组合的变化：英国初级保健中三种“新”非医疗角色的定性比较。
Skill-mix change in general practice: a qualitative comparison of three 'new' non-medical roles in English primary care.
机构信息
Alliance Manchester Business School.
Centre for Primary Care, University of Manchester, Manchester.
出版信息
Br J Gen Pract. 2019 Jul;69(684):e489-e498. doi: 10.3399/bjgp19X704117. Epub 2019 Jun 3.
BACKGROUND
General practice is currently facing a significant workforce challenge. Changing the general practice skill mix by introducing new non-medical roles is recommended as one solution; the literature highlights that organisational and/or operational difficulties are associated with skill-mix changes.
AIM
To compare how three non-medical roles were being established in general practice, understand common implementation barriers, and identify measurable impacts or unintended consequences.
DESIGN AND SETTING
In-depth qualitative comparison of three role initiatives in general practices in one area of Greater Manchester, England; that is, advanced practitioner and physician associate training schemes, and a locally commissioned practice pharmacist service.
METHOD
Semi-structured interviews and focus groups with a purposive sample of stakeholders involved in the implementation of each role initiative were conducted. Template analysis enabled the production of pre-determined and researcher-generated codes, categories, and themes.
RESULTS
The final sample contained 38 stakeholders comprising training/service leads, role holders, and host practice staff. Three key themes captured participants' perspectives: purpose and place of new roles in general practice, involving unclear role definition and tension at professional boundaries; transition of new roles into general practice, involving risk management, closing training-practice gaps and managing expectations; and future of new roles in general practice, involving demonstrating impact and questions about sustainability.
CONCLUSION
This in-depth, in-context comparative study highlights that introducing new roles to general practice is not a simple process. Recognition of factors affecting the assimilation of roles may help to better align them with the goals of general practice and harness the commitment of individual practices to enable role sustainability.
背景
全科医学目前面临着重大的劳动力挑战。通过引入新的非医疗角色来改变全科医学的技能组合被认为是一种解决方案；文献强调，技能组合的变化与组织和/或运营困难有关。
目的
比较三种非医疗角色在全科医学中的建立方式，了解常见的实施障碍，并确定可衡量的影响或意外后果。
设计和设置
在英格兰大曼彻斯特的一个地区，对三家全科实践中的三种角色举措进行深入的定性比较；即高级执业医师和医师助理培训计划，以及当地委托的执业药师服务。
方法
对参与每个角色举措实施的利益相关者进行有针对性的半结构化访谈和焦点小组讨论。模板分析使预先确定的和研究人员生成的代码、类别和主题得以生成。
结果
最终样本包含 38 名利益相关者，包括培训/服务负责人、角色持有者和所在实践的工作人员。三个关键主题捕捉了参与者的观点：新角色在全科医学中的目的和位置，涉及角色定义不明确和职业边界紧张；新角色向全科医学的过渡，涉及风险管理、缩小培训-实践差距和管理期望；以及新角色在全科医学中的未来，涉及展示影响和可持续性问题。
结论
这项深入的、背景相关的比较研究强调，向全科医学引入新角色并不是一个简单的过程。认识到影响角色同化的因素可能有助于更好地使角色与全科医学的目标保持一致，并利用个体实践的承诺来实现角色的可持续性。
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