Imperial College London, London, UK
Imperial College London, London, UK.
BMJ Open. 2019 Aug 20;9(8):e029702. doi: 10.1136/bmjopen-2019-029702.
There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (general practitioners and practice managers) towards these barriers to integration.
Qualitative study using semistructured interviews and thematic analysis to obtain results.
General practices within London.
18 general practitioners (GPs) and 7 practice managers (PMs) based in London with experience of working with social care.
The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between information systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors.
In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe that educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.
英国初级保健和社会保健之间的有效整合一直面临挑战；当前的系统导致服务碎片化，无法为弱势人群提供整体以患者为中心的护理。为了改善临床结果并实现财务效率，需要确定并解决整合的障碍。本研究旨在探讨一线工作人员（全科医生和诊所经理）对这些整合障碍的独特看法。
使用半结构化访谈和主题分析的定性研究，以获取结果。
伦敦的全科诊所。
18 名全科医生（GP）和 7 名来自伦敦的诊所经理（PM），他们有与社会保健合作的经验。
该研究确定了一线工作人员认为存在问题的三个总体主题：获取社会服务、专业间关系和基础设施。与其他部门的员工联系存在问题会导致患者护理转介延迟，并使现有后勤挑战持续存在。同样，专业人员指出，部门之间存在敌对的工作文化，导致孤立工作的心态。除了员工工作过度以及多学科团队会议效率低下外，部门之间关系不佳还导致责任扩散，影响患者请求的响应速度。此外，参与者还发现，信息系统之间缺乏互操作性、缺乏联合预算以及管理层之间激励措施不一致，加剧了两个部门之间的基础设施鸿沟。
在这项研究中，初级保健工作人员除了更详细描述的结构问题（如资金不足和难以获得社会关怀）外，还确定了整合的无形障碍，如专业间关系不佳。参与者认为，教育下一代医疗专业人员可能会导致建立协作而不是孤立的工作文化，并且需要在人际和机构层面进行变革，以成功整合护理。
