Pritzker School of Medicine, University of Chicago, Chicago, Illinois, USA.
Department of Medicine, Lenox Hill Hospital, New York City, New York, USA.
BMJ Open. 2021 Dec 1;11(12):e053784. doi: 10.1136/bmjopen-2021-053784.
To explore frequently hospitalised patients' experiences and preferences related to primary care physician (PCP) involvement during hospitalisation across two care models.
Qualitative study embedded within a randomised controlled trial. Semistructured interviews were conducted with patients. Transcripts were analysed using qualitative template analysis.
In the Comprehensive Care Programme (CCP) Study, in Illinois, USA, Medicare patients at increased risk of hospitalisation are randomly assigned to: (1) care by a CCP physician who serves as a PCP across both inpatient and outpatient settings or (2) care by a PCP as outpatient and by hospitalists as inpatients (standard care).
Twelve standard care and 12 CCP patients were interviewed.
Themes included: (1) Positive attitude towards PCP; (2) Longitudinal continuity with PCP valued; (3) Patient preference for PCP involvement in hospital care; (4) Potential for in-depth involvement of PCP during hospitalisation often unrealised (involvement rare in standard care; in CCP, frequent interaction with PCP fostered patient involvement in decision making); and (5) PCP collaboration with hospital-based providers frequently absent (no interaction for standard care patients; CCP patients emphasising PCP's role in interdisciplinary coordination).
Frequently hospitalised patients value PCP involvement in the hospital setting. CCP patients highlighted how an established relationship with their PCP improved interdisciplinary coordination and engagement with decision making. Inpatient-outpatient relational continuity may be an important component of programmes for frequently hospitalised patients. Opportunities for enhancing PCP involvement during hospitalisation should be considered.
探索两种护理模式下经常住院患者在住院期间与初级保健医生（PCP）参与相关的体验和偏好。
随机对照试验中嵌入的定性研究。对患者进行半结构化访谈。使用定性模板分析对转录本进行分析。
在美国伊利诺伊州的综合护理计划（CCP）研究中，有住院风险增加的 Medicare 患者被随机分配到以下两种护理方式：（1）由 CCP 医生护理，该医生在住院和门诊环境中均担任 PCP；（2）由 PCP 作为门诊医生，由医院医生作为住院医生（标准护理）。
共采访了 12 名标准护理患者和 12 名 CCP 患者。
主题包括：（1）对 PCP 的积极态度；（2）与 PCP 的纵向连续性受到重视；（3）患者希望 PCP 参与住院治疗；（4）PCP 在住院期间深度参与的潜力常常无法实现（在标准护理中很少见；在 CCP 中，与 PCP 的频繁互动促进了患者参与决策制定）；（5）PCP 与医院内提供者的合作常常缺失（标准护理患者没有互动；CCP 患者强调 PCP 在跨学科协调中的作用）。
经常住院的患者重视 PCP 在医院环境中的参与。CCP 患者强调了与他们的 PCP 建立关系如何改善了跨学科协调和参与决策制定。住院-门诊关系的连续性可能是经常住院患者计划的一个重要组成部分。应考虑为提高 PCP 在住院期间的参与度提供机会。
