School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada.
Health Soc Care Community. 2021 May;29(3):789-799. doi: 10.1111/hsc.13320. Epub 2021 Feb 19.
Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty-eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient-centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition.
加拿大的多发性硬化症（MS）发病率居世界之首，每 385 人中就有 1 人患病。这种神经退行性疾病的症状和病程不可预测且多变，难以治疗。加拿大的多发性硬化症患者高度依赖医疗保健服务；然而，他们报告存在多种未满足的需求、疾病负担高以及对医疗保健的满意度低。获得医疗保健对于维护健康至关重要，这可能解释了这些不良体验的原因。医疗保健的可及性通常使用利用率作为替代指标来衡量，但这可能无法捕捉到该人群面临的复杂的可及性体验。候选框架提供了一种替代利用率措施的方法，通过检查获得护理的过程，同时考虑社会模式和卫生系统环境对这一过程的影响。本研究的目的是将多发性硬化症患者获得医疗保健服务的体验与候选框架的各个阶段相匹配。在安大略省各地招募了 48 名多发性硬化症患者参加了五组焦点小组或十次个人访谈。分析包括使用恒定性比较方法的初步归纳阶段，以及使用内容分析的演绎阶段。候选框架无法捕捉到多发性硬化症患者所分享的所有体验，包括以患者为中心的护理、过去的经验和结果预期以及护理结果。我们建议将这些概念纳入当前框架的修订版中，为多发性硬化症患者在获得护理以管理其病情方面的体验提供更全面的解释。
