Elgen Irene, Heggestad Torhild, Tronstad Rune, Greve Gottfried
Division of Psychiatry, Department of Child and Adolescent, Haukeland University Hospital, Bergen, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Front Pediatr. 2021 Dec 22;9:721926. doi: 10.3389/fped.2021.721926. eCollection 2021.
During the last decades, there is a major shift in the panorama of diseases in children and adolescents. More children are referred to the specialized health care services due to less specific symptoms and more complex health challenges. These children are particularly difficult to care for in a "single-disease" oriented system. Our objective was to develop an alternative and more holistic approach better tailored to the complex needs of these children. The target patient population is children between 6 and 13 years with three or more referrals including both the pediatric department and the mental health services. Furthermore, to be included in the project, the child's actual complaints needed to be clinically considered as an unclear or compound condition in need of an alternative approach. This paper describes the process of developing an intervention where a complementary professional team meets the patient and his/her family altogether for 2.5 h. The consultation focus on clarifying the complex symptomatology and on problem solving. The bio-psycho-social model is applied, emphasizing the patient's story as told on the whiteboard. In the dynamic processes of development, piloting, evaluating, and adjusting the components, feed-back from the patients, their families, professional team members, and external team coaches is important. The professional teams include pediatricians, psychologists and physiotherapists. Achieving the transformation from a logistic oriented team where members act separately toward a real complementary team, seems to be a success factor. Composing multi-disciplinary and complementary teams was an essential part of the re-designed intervention. Team interaction transforming the professionals from working as a logistic team to act as a complementary team, was one of the important requirements in the process. When re-designing the specialist health service, it is mandatory to anchor all changes among employees as well as the hospital leadership. In addition, it is important to include patient experiences in the process of improvement. Evaluation of long-term outcomes is needed to investigate possible benefits from the new intervention. Transitioning Young Patients' Health Care Trajectories, NCT04652154. Registered December 3rd, 2020-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04652154?term=NCT04652154&draw=2&rank=1.
在过去几十年里，儿童和青少年的疾病谱发生了重大变化。由于症状不那么典型且健康挑战更为复杂，越来越多的儿童被转诊至专业医疗服务机构。在一个以“单一疾病”为导向的体系中，照顾这些儿童格外困难。我们的目标是开发一种更具替代性且更全面的方法，以更好地满足这些儿童的复杂需求。目标患者群体是6至13岁、有三次或更多次转诊记录的儿童，转诊科室包括儿科和心理健康服务科室。此外，要纳入该项目，孩子当前的症状在临床上需被视为不明确或复杂的情况，需要采用替代方法来处理。本文描述了开发一种干预措施的过程，即一个互补性专业团队与患者及其家人共同会面2.5小时。会诊重点在于厘清复杂的症状表现并解决问题。采用生物 - 心理 - 社会模型，强调患者在白板上讲述的经历。在干预措施各组成部分的动态开发、试点、评估和调整过程中，来自患者、其家人、专业团队成员以及外部团队指导者的反馈很重要。专业团队包括儿科医生、心理学家和物理治疗师。实现从成员各自为政的后勤型团队向真正的互补性团队的转变，似乎是一个成功因素。组建多学科互补团队是重新设计的干预措施的重要组成部分。团队互动使专业人员从后勤型团队工作模式转变为互补型团队工作模式，是该过程中的重要要求之一。在重新设计专科医疗服务时，必须让员工以及医院领导层都接受所有变革。此外，在改进过程中纳入患者体验很重要。需要对长期结果进行评估，以调查新干预措施可能带来的益处。《转变年轻患者的医疗轨迹》，NCT04652154。于2020年12月3日注册——追溯注册，https://clinicaltrials.gov/ct2/show/NCT04652154?term=NCT04652154&draw=2&rank=1 。
