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初级保健中的自我管理支持活动:一项比较常见健康问题服务提供情况的定性研究。

Self-management support activities in primary care: A qualitative study to compare provision across common health problems.

作者信息

Harris Emma, Barker Caroline, Burton Kim, Lucock Mike, Astin Felicity

机构信息

School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.

School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.

出版信息

Patient Educ Couns. 2020 Jul 7. doi: 10.1016/j.pec.2020.07.003.

Abstract

OBJECTIVE

To explore the views of primary care teams about the provision of self-management support to patients with common health problems.

METHODS

Semi-structured interviews were conducted with twenty-one members of the primary care team from thirteen general practices. Interviews were transcribed verbatim, and analysed using the 'Framework' approach.

RESULTS

Three categories and six sub-categories illustrating different self-management support activities across common health problems were identified from the analysis of interviews, and contributed to one major theme and one cross-cutting theme. Referral and signposting were frequently used to facilitate patient engagement with external services and resources. Practitioners faced some challenges in balancing medical management and psychosocial support and motivating patients to engage with self-management.

CONCLUSIONS

Primary care teams described providing a wide range of self-management support activities, but the pattern of use varied for different types of health problem. These patterns may have been influenced, in part, by general practices focusing upon achieving financially incentivised quality improvement goals.

PRACTICE IMPLICATIONS

To improve self-management support, practitioners need a digital repository of services/resources, motivational interviewing skills, an understanding of the optimum duration and pattern of consultations, and incentivised targets that match a biopsychosocial model of care.

摘要

目的

探讨基层医疗团队对为患有常见健康问题的患者提供自我管理支持的看法。

方法

对来自13家全科诊所的21名基层医疗团队成员进行了半结构化访谈。访谈内容逐字转录,并采用“框架”方法进行分析。

结果

通过对访谈的分析,确定了三类和六个子类别,这些类别说明了常见健康问题中不同的自我管理支持活动,并促成了一个主要主题和一个贯穿各领域的主题。转诊和提供信息经常被用于促进患者与外部服务和资源的接触。从业者在平衡医疗管理和心理社会支持以及激励患者参与自我管理方面面临一些挑战。

结论

基层医疗团队描述了提供广泛的自我管理支持活动,但不同类型健康问题的使用模式各不相同。这些模式可能部分受到专注于实现经济激励的质量改进目标的全科诊所的影响。

实践意义

为了改善自我管理支持,从业者需要一个服务/资源的数字存储库、动机性访谈技巧、对最佳咨询时长和模式的理解,以及与生物心理社会护理模式相匹配的激励目标。

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