Département de Médecine de Famille et de Médecine d'urgence, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
Département de Médecine de Famille, Université McGill, Montreal, Quebec, Canada.
BMJ Open. 2020 Sep 9;10(9):e033351. doi: 10.1136/bmjopen-2019-033351.
Frequent users of healthcare services are often categorised as 'heavy-cost patients'. In the recent years, many jurisdictions have attempted to implement different public policies to optimise the use of health services by frequent users. However, throughout this process, little attention has been paid to their experience as patients.
To thematically synthesise qualitative studies that explore the experience of frequent users of primary care and emergency department services.
Qualitative systematic review and thematic synthesis.
Primary care and emergency department.
Frequent users of primary care and emergency department services.
A qualitative systematic review was conducted using three online databases (MEDLINE with full text, CINAHL with full text and PsycINFO). This search was combined to an extensive manual search of reference lists and related citations. A thematic synthesis was performed to develop descriptive themes and analytical constructs.
Twelve studies were included. All included studies met the following inclusion criteria: qualitative design; published in English; discussed frequent users' experiences from their own perspectives and users' experiences occurred in primary care and/or emergency departments.
The predominant aspects of frequent users' experiences were: (1) the experience of being ill and (2) the healthcare experience. The experience of being ill encompassed four central themes: physical limitations, mental suffering, impact on relationships and the role of self-management. The healthcare experience embraced the experience of accessing healthcare and the global experience of receiving care.
This synthesis sheds light on potential changes to healthcare delivery in order to improve frequent users' experiences: individualised care plans or case management interventions to support self-management of symptoms and reduce psychological distress; and giving greater importance on the patient-providers relationship as a central facet of healthcare delivery. This synthesis also highlights future research directions that would benefit frequent users.
医疗服务的频繁使用者通常被归类为“高成本患者”。近年来，许多司法管辖区试图实施不同的公共政策，以优化频繁使用者对卫生服务的使用。然而，在这一过程中，很少关注他们作为患者的体验。
对探索初级保健和急诊服务频繁使用者体验的定性研究进行主题综合分析。
定性系统评价和主题综合分析。
初级保健和急诊。
初级保健和急诊服务的频繁使用者。
使用三个在线数据库（全文 MEDLINE、全文 CINAHL 和 PsycINFO）进行定性系统评价。该搜索与参考列表和相关引文的广泛手动搜索相结合。进行主题综合分析以开发描述性主题和分析结构。
纳入了 12 项研究。所有纳入的研究均符合以下纳入标准：定性设计；以英文发表；从自身角度讨论频繁使用者的体验，且使用者的体验发生在初级保健和/或急诊部门。
频繁使用者体验的主要方面是：（1）患病体验和（2）医疗保健体验。患病体验包括四个核心主题：身体限制、精神痛苦、对人际关系的影响和自我管理的作用。医疗保健体验包括获得医疗保健的体验和接受医疗保健的整体体验。
该综合分析揭示了为改善频繁使用者的体验而改变医疗服务提供方式的潜在方法：个性化护理计划或病例管理干预措施，以支持症状的自我管理和减轻心理困扰；并更加重视患者与提供者的关系作为医疗服务提供的核心方面。该综合分析还强调了有益于频繁使用者的未来研究方向。
