School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
Academy of Postgraduate Medical Education, Maastricht University Medical Centre+, Maastricht, The Netherlands.
BMJ Open. 2021 Nov 24;11(11):e052688. doi: 10.1136/bmjopen-2021-052688.
To explore how residents experienced the application of the Positive Health dialogue tool (PH-tool) during outpatient consultations and its influence on the delivery of value-based healthcare (VBHC).
Qualitative study using non-participant observations of outpatient consultations during which residents used the PH-tool, followed by longitudinal individual, semistructured interviews. To analyse the data from observations and interviews, observational form notes' summarisation and categorisation, and an iterative-inductive thematic approach was used.
Eight residents-five from the ear, nose, and throat-department and three from the gastroenterology-hepatology-department-were selected through convenience sampling, accounting for 79 observations and 79 interviews.
Residents had bivalent experiences with using the PH-tool. Residents discussed three main benefits: a gained insight into the individual patient's context and functioning, a changed dynamics in resident-patient communication, and an increased awareness regarding value in terms of patient-related outcomes and healthcare costs. Three barriers became apparent: doubts regarding the PH-tool's relevance and scope, boundaries of superspecialised medical professionals, and a lack of demarcation in clinical practice.
The PH-tool use can be beneficial for residents during outpatient consultations with new patients and follow-up in cases of multidimensional problems, particularly in cases of chronic conditions and generalist care. In these situations, the tool yielded valuable patient information beyond physical health, helped foster patient engagement, and enabled tailoring the treatment plan to individual patients' needs. On the other hand, the PH-tool was not a good fit for simple problems, clearly demarcated help requests, periodic follow-up consultations, or verbose patients. In addition, it was not suitable for superspecialised care, because it yielded an abundance of general information. For particular patients and problems, using the PH-tool seems a promising strategy to increase VBHC delivery. Nevertheless, further research and detailing is needed to better align the PH-tool's broad intent and clinical practice.
探讨住院医师在门诊咨询中应用积极健康对话工具（PH 工具）的体验，及其对提供基于价值的医疗保健（VBHC）的影响。
采用非参与式观察法，观察住院医师使用 PH 工具的门诊咨询，随后进行纵向个体半结构化访谈。对观察和访谈数据进行分析时，采用观察表单记录的总结和分类以及迭代式归纳主题方法。
通过便利抽样选择了 8 名住院医师——5 名来自耳鼻喉科，3 名来自胃肠肝病科，共进行了 79 次观察和 79 次访谈。
住院医师使用 PH 工具的体验具有双重性。住院医师讨论了三个主要好处：深入了解患者的个体情况和功能，改变住院医师与患者沟通的动态，以及提高对患者相关结果和医疗保健成本方面的价值的认识。出现了三个障碍：对 PH 工具的相关性和范围的怀疑，专科医生的界限，以及临床实践中缺乏明确区分。
PH 工具在新患者的门诊咨询和多维问题的随访中对住院医师可能有益，特别是在慢性疾病和通科医疗的情况下。在这些情况下，该工具提供了超越身体健康的有价值的患者信息，有助于促进患者参与，并使治疗计划能够适应患者的个体需求。另一方面，PH 工具不适合简单的问题、明确的求助请求、定期随访咨询或啰嗦的患者。此外，它不适合专科医疗，因为它提供了大量的一般信息。对于特定的患者和问题，使用 PH 工具似乎是提高 VBHC 提供的一种有前途的策略。然而，需要进一步的研究和详细说明，以更好地调整 PH 工具的广泛意图和临床实践。
