社区卫生中心初级保健医生对未参保患者哮喘管理的认知
Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients.
作者信息
Bynum Mary
机构信息
Mary Bynum, MA, BSN, RN, CCM, DHA, is the Department Chair for Healthcare Programs, Program Chair for the Healthcare Management Program, and Lead Faculty for the Public Administration Program at Franklin University. Dr. Bynum received her doctorate in Health Administration from the University of Phoenix. In addition, she holds a Master of Arts in Public Policy and Management and Bachelor of Science in Nursing from the Ohio State University. Dr. Bynum is a certified case manager and a registered nurse. She has an extensive background in operational excellence, project management, regulatory adherence, and health care policy. She has served more than 22 years in both the public and private sectors. Her research interests include vulnerable populations, health disparities, health policy, and social determinants of health. Dr. Bynum is a national speaker and wellness enthusiast. She is a member of Alpha Kappa Alpha Sorority, Incorporated, Franklin County Children Services Citizens Advisory Committee, Central Ohio Case Management Network, and Fort Hayes Metropolitan Education Center Health Science and Dental Hygiene Advisory Board and is the founder of the Legacy Group of Ohio. She is the recipient of the Stephan Shank award for Teaching Excellence. In addition, she is a marathon runner and fitness guru.
出版信息
Prof Case Manag. 2020 Nov/Dec;25(6):335-342. doi: 10.1097/NCM.0000000000000406.
PURPOSE OF STUDY
Explore the perceptions of primary care physicians (PCPs) from community health care centers (CHCs) in Franklin County, Ohio, regarding factors that contribute to their inability to consistently provide sustainable asthma management services to their uninsured patient population.
PRIMARY PRACTICE SETTING
Asthmatic patients are not consistently receiving sustainable asthma management in CHCs in Ohio. Primary care physicians in CHCs play a pivotal role in closing health care gaps for asthmatic patients. To minimize the barriers that impede the efforts of PCPs to control asthma for their uninsured patients, asthma disease management programs that include case management services in CHCs in Franklin County, Ohio, are needed.
METHODOLOGY AND SAMPLE
A convenience sample of 4 PCPs from 2 CHCs in Franklin County, Ohio, was interviewed face-to-face. Interviews, direct observation, and previously published research were the sources of data utilized for this study.
RESULTS
Results indicated that 75% of participants did not use standard guidelines while treating their patients. Physician time constraints and access to affordable medication were identified as some of the barriers to providing sustainable asthma management services.
IMPLICATIONS FOR CASE MANAGEMENT
Asthma is a complex chronic disease. Disease case managers not only are capable of coordinating health care services for a variety of patient populations but are also effective in managing complex diseases such as asthma for disadvantaged populations. Evidence-based case management models are needed to support PCPs in CHCs. Without the inclusion of asthma-specific case managers as part of the care delivery structure, CHCs may continue to provide subpar disease management services for uninsured asthmatic patients.
研究目的
探讨俄亥俄州富兰克林县社区卫生中心（CHC）的初级保健医生（PCP）对导致他们无法持续为未参保患者群体提供可持续哮喘管理服务的因素的看法。
主要实践背景
俄亥俄州社区卫生中心的哮喘患者未能持续获得可持续的哮喘管理服务。社区卫生中心的初级保健医生在缩小哮喘患者的医疗保健差距方面发挥着关键作用。为了尽量减少阻碍初级保健医生为未参保患者控制哮喘的障碍，需要在俄亥俄州富兰克林县的社区卫生中心开展包括病例管理服务在内的哮喘疾病管理项目。
方法与样本
对来自俄亥俄州富兰克林县2个社区卫生中心的4名初级保健医生进行了便利抽样面对面访谈。访谈、直接观察和先前发表的研究是本研究使用的数据来源。
结果
结果表明，75%的参与者在治疗患者时未使用标准指南。医生的时间限制和获得负担得起的药物被确定为提供可持续哮喘管理服务的一些障碍。
对病例管理的启示
哮喘是一种复杂的慢性病。疾病病例管理人员不仅能够为各种患者群体协调医疗服务，而且在为弱势群体管理哮喘等复杂疾病方面也很有效。需要基于证据的病例管理模式来支持社区卫生中心的初级保健医生。如果不将特定于哮喘的病例管理人员纳入护理提供结构的一部分，社区卫生中心可能会继续为未参保的哮喘患者提供低于标准的疾病管理服务。
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