数字工具能否促进慢性病护理中以患者为中心的护理实践？来自风湿病护理领域医疗专业人员的经验。
Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals' experiences from rheumatology care.
作者信息
Granström Emma, Wannheden Carolina, Brommels Mats, Hvitfeldt Helena, Nyström Monica E
机构信息
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, SE-17177 Stockholm, Sweden.
Norrtälje Hospital, FoUU, SE-76129 Norrtälje, Sweden.
出版信息
BMC Health Serv Res. 2020 Dec 1;20(1):1108. doi: 10.1186/s12913-020-05945-5.
BACKGROUND
Person-centered care (PCC) emphasize the importance of supporting individuals' involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies' relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients.
METHODS
A single case study design was used. The qualitative data consisted of 14 semi-structured interviews and staff meeting minutes, covering the time period 2017-2019. The data were analyzed using conventional content analysis, complemented with document analyses.
RESULTS
Ten strategies on two levels to operationalize PCC, and three categories of perceived impact were identified. On the individual patient level strategies involved several digital tools focusing on flexible access to care, mutual information sharing and the distribution of initiatives, tasks, and responsibilities from provider to patients. On the unit level, strategies concerned involving patient representatives and individual patients in development of digital services and work practices. The roles of both professionals and patients were affected and the importance of behavioral and cultural change became clear.
CONCLUSIONS
By providing an empirical example from chronic care the study contributes to the knowledge on strategies for achieving PCC, how digital tools and work practices interact, and how they can affect healthcare staff, patients and the unit. A conclusion is that the use of the digital tools, spanning over different dimensions of engagement, facilitated the healthcare professionals' interaction with patients and the patients' involvement in their own care. Digital tools complemented, rather than replaced, care practices.
背景
以患者为中心的护理（PCC）强调支持个体参与所接受的护理和自我护理的重要性。随着人口结构变化导致慢性病患者数量增加，PCC在慢性病护理中变得愈发重要。数字工具具有支持患者与医疗服务提供者之间互动的潜力，但关于如何在慢性病护理中实现PCC以及数字工具在此过程中的作用的实证案例有限。本研究的目的是调查门诊风湿病诊所（RC）的医疗专业人员用于实现PCC的策略、这些策略与数字工具的关系，以及这些策略对医疗专业人员和患者的感知影响。
方法
采用单案例研究设计。定性数据包括2017 - 2019年期间的14次半结构化访谈和员工会议记录。数据采用传统内容分析法进行分析，并辅以文件分析。
结果
确定了两个层面上用于实施PCC的10项策略以及三类感知影响。在个体患者层面，策略涉及多种数字工具，重点在于灵活获得护理、相互信息共享以及将举措、任务和责任从提供者分配给患者。在科室层面，策略涉及让患者代表和个体患者参与数字服务和工作实践的开发。专业人员和患者的角色都受到了影响，行为和文化变革的重要性变得清晰。
结论
通过提供慢性病护理的实证案例，本研究有助于了解实现PCC的策略、数字工具与工作实践如何相互作用，以及它们如何影响医护人员、患者和科室。得出的一个结论是，跨越不同参与维度使用数字工具促进了医疗专业人员与患者的互动以及患者对自身护理的参与。数字工具补充而非取代了护理实践。
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