“我们需要让他们走出阴影：”一项关于安全网医师领导者对照护者看法的定性研究。
"We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers.
机构信息
Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA; Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA.
出版信息
Patient Educ Couns. 2022 Jun;105(6):1663-1670. doi: 10.1016/j.pec.2021.10.019. Epub 2021 Oct 23.
OBJECTIVE
To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems.
METHODS
We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes.
RESULTS
Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver.
CONCLUSIONS
Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers.
PRACTICE IMPLICATIONS
Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.
目的
探讨医师领导者在其临床实践以及在其医疗保障体系中与照护者互动的过程和优先事项的看法。
方法
我们对加州三家医疗保障体系中从事照护管理的初级保健医生进行了深入的半结构式访谈。访谈内容探讨了医生在管理具有医疗和社会复杂性的患者及其照护者方面的经验。使用主题分析方法，两位定性研究人员独立分析访谈记录，并通过迭代输入与更广泛的研究团队达成共识，以得出主要主题。
结果
15 名医生完成了访谈。9 名参与者为女性，8 名参与者为白人，10 名参与者报告西班牙语熟练程度。参与者的访谈产生了六个主要主题：发现照护者身份的挑战、认识到照护者角色的差异、调整就诊沟通策略以包括照护者、让照护者参与患者护理以及照顾照护者。
结论
鉴于医疗保障体系对照护者参与患者护理的有限认识，与照护者互动具有挑战性。适应就诊沟通以包括照护者需要跨越语言和读写障碍。
实践意义
开发能够持续识别患者照护者、促进与照护者的持续沟通并为其提供支持的机制，可以改善弱势患者及其家庭的预后。
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