通过患者、护士和医生的声音了解加拿大不列颠哥伦比亚省风湿性疾病患者的多学科护理：一项定性政策评估。
Understanding multidisciplinary care for people with rheumatic disease in British Columbia, Canada, through patients, nurses and physicians voices: a qualitative policy evaluation.
机构信息
Faculty of Pharmaceutical Sciences, University of British Columbia, 2405-4625 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada.
出版信息
BMC Health Serv Res. 2021 Oct 23;21(1):1148. doi: 10.1186/s12913-021-07138-0.
BACKGROUND
In 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a 'Multidisciplinary Care Assessments' (MCA) billing code (G31060).
OBJECTIVE
To describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists.
METHODS
We conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 - August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed.
RESULTS
We interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed.
CONCLUSION
Our results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals' skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients.
背景
2011 年，不列颠哥伦比亚省（BC）通过引入“多学科护理评估”（MCA）计费代码（G31060），允许复杂风湿病患者在与风湿病专家一起接受护士的治疗。
目的
描述 BC 引入的多学科护理，并从患者、护士和风湿病专家的角度调查这种干预措施（将护士添加到护理团队中）对患者护理的感知影响。
方法
我们于 2019 年 9 月至 2020 年 8 月间进行了半结构化访谈，采用定性评估方法对患者、护士和风湿病专家进行了调查。访谈调查了 1）所有利益相关者采用多学科护理计费代码的经验，2）护士在护理团队中的感知角色，以及 3）多学科护理对患者体验和结果的感知影响。我们从地理区域（农村与城市）、实践规模（即患者病例量）和雇佣护士人数等方面对实践进行了有针对性的抽样，以获得最大的变化。
结果
我们采访了来自 BC 的 21 名患者、13 名护士和 12 名风湿病专家。我们的分析确定了 BC 内风湿病医生采用多学科护理的方式存在差异。我们的分析表明，MCA 在风湿病实践中的实施方式存在一些差异；然而，患者教育被确定为护士在整个实践中的核心角色。我们确定了六个核心主题，描述了这种护理模式的影响，所有这些主题都代表了实践运作方式的改进，从提高效率到获得、患者体验、时间管理、临床医生体验和患者健康结果。影响这些主题存在的背景因素与护士与患者接触的时间以及他们执行的专业角色有关。
结论
我们的研究结果表明，护士的护理可以通过延长患者的接触时间并促进医疗保健专业人员技能、时间和资源的有效利用，补充医生的护理。这些数据可能会鼓励未来采用计费代码，以确保该政策为患者带来最大利益，因为临床医生和患者都描述了广泛的受益。
Zotero 插件