Kumlin Marianne, Berg Geir Vegar, Kvigne Kari, Hellesø Ragnhild
Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences Elverum, Elverum, Norway.
Innlandet Hospital Trust, Lillehammer, Norway.
J Multidiscip Healthc. 2021 Mar 4;14:567-575. doi: 10.2147/JMDH.S298713. eCollection 2021.
Today, seamless, person-centered healthcare is emphasized when dealing with elderly patients with comprehensive needs. Studies have uncovered a complex healthcare terrain. Despite a great deal of effort on the part of policy makers and healthcare providers, the work healthcare professionals undertake to develop seamless healthcare is still unclear. Therefore, the aim of this study was to uncover the work that healthcare professionals undertake to achieve coherent and comprehensive healthcare for elderly patients with multiple health problems during their journey through the complex healthcare terrain.
This study has an explorative design with individual interviews. Twenty-five healthcare professionals from primary and specialist care agreed to participate. A thematic analysis method was employed.
The analyses revealed three central themes in the healthcare professionals' work to build coherence in the patients' care trajectory: Working to manage a patient's illness trajectory during the course of the patient's life, working to achieve a comprehensive overall picture, and considering multiple options in a "patchwork" terrain.
Healthcare professionals have a common understanding that hospital stays are a short part of the elderly person's journey in the healthcare system. In the comprehensive work to obtain the overall picture of the illness trajectory within the patient's life story, healthcare professionals emphasized the importance of working in an interdisciplinary manner. Interprofessional consulting and collaboration should be strengthened to build coherence in the older patient's complex care trajectory.
如今，在应对有综合需求的老年患者时，强调提供无缝衔接的、以患者为中心的医疗服务。研究发现了复杂的医疗保健领域。尽管政策制定者和医疗服务提供者付出了巨大努力，但医疗保健专业人员为发展无缝医疗保健所做的工作仍不明确。因此，本研究的目的是揭示医疗保健专业人员在复杂的医疗保健领域中，为患有多种健康问题的老年患者提供连贯且全面的医疗保健时所开展的工作。
本研究采用探索性设计，进行个人访谈。来自初级保健和专科护理的25名医疗保健专业人员同意参与。采用主题分析法。
分析揭示了医疗保健专业人员在构建患者护理轨迹连贯性工作中的三个核心主题：在患者生命过程中努力管理患者的疾病轨迹、努力形成全面的整体情况，以及在“拼凑”的领域中考虑多种选择。
医疗保健专业人员有一个共同的认识，即住院只是老年人在医疗保健系统中旅程的一小部分。在全面了解患者生命故事中的疾病轨迹整体情况的工作中，医疗保健专业人员强调跨学科工作的重要性。应加强跨专业咨询与合作，以构建老年患者复杂护理轨迹的连贯性。
