Inland Norway University of Applied Sciences, Elverum, Norway.
Innlandet Hospital Trust, Lillehammer, Norway.
BMC Health Serv Res. 2020 Jun 29;20(1):595. doi: 10.1186/s12913-020-05437-6.
Elderly patients with multiple health problems often experience disease complications and functional failure, resulting in a need for health care across different health care systems during care trajectory. The patients' perspective of the care trajectory has been insufficiently described, and thus there is a need for new insights and understanding. The study aims to explore how elderly patients with complex health problems engage in and interact with their care trajectory across different health care systems where several health care personnel are involved.
The study had an explorative design with a qualitative multi-case approach. Eleven patients (n = 11) aged 65-91 years participated. Patients were recruited from two hospitals in Norway. Observations and repeated interviews were conducted during patients' hospital stays, discharge and after they returned to their homes. A thematic analysis method was undertaken.
Patients engaged and positioned themselves in the care trajectory according to three identified themes: 1) the patients constantly considered opportunities and alternatives for handling the different challenges and situations they faced; 2) patients searched for appropriate alliance partners to support them and 3) patients sometimes circumvented the health care initiation of planned steps and took different directions in their care trajectory.
The patients' considerations of their health care needs and adjustments to living arrangements are constant throughout care trajectories. These considerations are often long term, and the patient engagement in and management of their care trajectory is not associated with particular times or situations. Achieving consistency between the health care system and the patient's pace in the decision-making process may lead to a more appropriate level of health care in line with the patient's preferences and goals.
患有多种健康问题的老年患者经常会出现疾病并发症和功能衰竭，导致在护理轨迹中需要在不同的医疗保健系统中获得医疗保健。患者对护理轨迹的看法描述不足，因此需要新的见解和理解。本研究旨在探讨患有复杂健康问题的老年患者如何在涉及多名医疗保健人员的不同医疗保健系统中参与并互动他们的护理轨迹。
该研究采用探索性设计和定性多案例方法。11 名年龄在 65-91 岁的患者（n=11）参与了研究。患者是从挪威的两家医院招募的。在患者住院、出院后和返回家中期间，进行了观察和重复访谈。采用主题分析方法。
患者根据三个确定的主题参与并定位自己的护理轨迹：1）患者不断考虑处理他们面临的不同挑战和情况的机会和选择；2）患者寻找合适的联盟伙伴来支持他们；3）患者有时会规避计划步骤的医疗保健启动，并在他们的护理轨迹中采取不同的方向。
患者对他们的医疗保健需求的考虑和对生活安排的调整是护理轨迹中持续的。这些考虑通常是长期的，患者参与和管理他们的护理轨迹与特定的时间或情况无关。在决策过程中实现医疗保健系统和患者步伐之间的一致性，可能会导致更符合患者偏好和目标的适当医疗保健水平。
