Institute of Health and Wellbeing, College of Social Sciences, University of Glasgow, Glasgow, G12 8RS, UK.
Faculty of Health, Education, Medicine & Social Care, Anglia Ruskin University, Cambridge, CB1 1PT, UK.
BMC Health Serv Res. 2020 Mar 19;20(1):235. doi: 10.1186/s12913-020-05109-5.
As diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers. 'Integrated care', while representing a range of approaches, has been positioned as a promising solution with potential to benefit patients and health systems. This is particularly the case in rural populations which are often removed from centres of specialist care. The social arrangements within diabetes integrated care initiatives are understudied but are of particular importance to those implementing such initiatives. In this paper we explore the 'work' of integration through an analysis of the role played by Health Care Assistants (HCAs) who were specially trained in aspects of diabetes care and given the title 'Diabetes Care Technician' (DCT).
Using thematic analysis of interview (n = 55) and observation data (n = 40), we look at: how the role of DCTs was understood by patients and other HCPs, as well as the DCTs; and explore what DCTs did within the integrated care initiative.
Our findings suggested that the DCTs saw their role as part of a hierarchy, providing links between members of the integrated team, and explaining and validating clinical decisions. Patients characterised DCTs as friends and advisors who provided continuity. Other HCPs perceived the DCTs as supportive, providing long-term monitoring and doing a different job to conventional HCAs. We found that DCTs had to navigate local terrain (social, ethical and physical), engage in significant conversation and negotiate treatment plans created through integrated care. The analysis suggests that relationships between patients and the DCTs were strong, had the quality of friendship and mitigated loneliness.
DCTs played multidimensional roles in the integrated care initiative that required great social and emotional skill. Building friendships with patients was central to their work, which mitigated loneliness and facilitated the care they provided.
随着全球糖尿病患病率的上升，医疗保健专业人员 (HCP)、卫生服务研究人员、患者群体和政策制定者越来越多地讨论诊所和护理方案的安排。“综合护理”虽然代表了一系列方法，但被认为是一种有前途的解决方案，有可能使患者和卫生系统受益。在农村地区尤其如此，这些地区往往远离专科护理中心。糖尿病综合护理计划中的社会安排研究不足，但对实施此类计划的人来说尤为重要。在本文中，我们通过分析专门接受过糖尿病护理方面培训并被授予“糖尿病护理技术员” (DCT) 称号的医疗保健助理 (HCA) 所扮演的角色来探讨“整合”的“工作”。
我们使用对访谈 (n=55) 和观察数据 (n=40) 的主题分析，研究了：DCT 对患者和其他 HCP 以及对自身角色的理解；以及探索 DCT 在综合护理计划中所做的工作。
我们的研究结果表明，DCT 认为自己的角色是团队成员之间联系的一部分，负责解释和验证临床决策。患者将 DCT 描述为朋友和顾问，提供了连续性。其他 HCP 认为 DCT 很有帮助，能够提供长期监测并执行与传统 HCAs 不同的工作。我们发现 DCT 必须在当地环境中（社会、道德和身体）进行导航，进行大量对话，并协商通过综合护理创建的治疗计划。分析表明，患者与 DCT 之间的关系牢固，具有友谊的品质，减轻了孤独感。
DCT 在综合护理计划中扮演着多维度的角色，需要具备出色的社交和情感技能。与患者建立友谊是他们工作的核心，这有助于减轻孤独感并促进他们提供的护理。
