Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada.
Fam Pract. 2021 Jul 28;38(4):416-424. doi: 10.1093/fampra/cmab006.
There is little literature related to access to inflammatory bowel disease (IBD) care that incorporates the perspective of key system stakeholders, such as primary healthcare providers (PHCP), despite their clear and integral role in facilitating access.
This study aimed to identify barriers to referring patients to speciality IBD care as perceived by referring PHCP. In particular, we sought to understand PHCP satisfaction with the current IBD specialist referral system, as well as indicators of geographic variance to access.
A population-based survey was mailed out to currently practising PHCPs who have referred or who are currently referring patients to IBD speciality care in Nova Scotia (Canada). Descriptive statistics and multivariate analyses were performed. Qualitative comments were themed using framework analysis to identify key barriers.
The majority of PHCP (57%) were dissatisfied with the current referral process due to long patient wait times and perceived system inefficiency. Key areas of geographic variance in access included access to speciality care in the community and patient wait times. PHCPs suggested ideas to improve access including increased gastroenterologist supply, particularly in rural areas, and the creation of a provincial centralized referral and triage process.
PHCPs play an important role in identifying and managing patients with IBD in partnership with gastroenterologists. This study identifies key PHCP perceived barriers that may prevent patients from accessing speciality IBD care. Understanding and addressing barriers to access from multiple stakeholder perspectives, including PHCPs, has the potential to support informed system redesign and overcome access inequities.
尽管初级保健提供者（PHCP）在促进获得炎症性肠病（IBD）护理方面发挥着明确而不可或缺的作用，但与获取 IBD 护理相关的文献很少纳入这些关键系统利益相关者的观点。
本研究旨在确定初级保健医生认为的将患者转介到专业 IBD 护理的障碍。特别是，我们试图了解 PHCP 对当前 IBD 专科转诊系统的满意度，以及获得专科护理的地理差异指标。
对在加拿大新斯科舍省从事过或正在将患者转诊到 IBD 专科护理的现任 PHCP 进行了一项基于人群的邮寄调查。进行了描述性统计和多变量分析。使用框架分析对定性评论进行主题分析，以确定主要障碍。
大多数 PHCP（57%）对当前的转诊流程不满意，原因是患者等待时间长和系统效率低下。获得专科护理的地理差异的主要领域包括在社区获得专科护理和患者等待时间。PHCP 提出了改善获得专科护理的建议，包括增加胃肠病学家的供应，特别是在农村地区，以及建立省级集中转诊和分诊流程。
PHCP 与胃肠病学家合作，在识别和管理 IBD 患者方面发挥着重要作用。本研究确定了 PHCP 认为可能阻碍患者获得专业 IBD 护理的主要障碍。从多个利益相关者的角度，包括 PHCP，了解和解决获得护理的障碍，有可能支持系统的明智重新设计并克服获得护理的不平等。
