Research, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States of America.
University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States of America.
PLoS One. 2022 Feb 7;17(2):e0263498. doi: 10.1371/journal.pone.0263498. eCollection 2022.
Shared medical appointments (SMAs) offer a means for providing knowledge and skills needed for chronic disease management to patients. However, SMAs require a time and attention investment from health care providers, who must understand the goals and potential benefits of SMAs from the perspective of patients and providers. To better understand how to gain provider engagement and inform future SMA implementation, qualitative inquiry of provider experience based on a knowledge-attitude-practice model was explored. Semi-structured interviews were conducted with 24 health care providers leading SMAs for heart failure at three Veterans Administration Medical Centers. Rapid matrix analysis process techniques including team-based qualitative inquiry followed by stakeholder validation was employed. The interview guide followed a knowledge-attitude-practice model with a priori domains of knowledge of SMA structure and content (understanding of how SMAs were structured), SMA attitude/beliefs (general expectations about SMA use), attitudes regarding how leading SMAs affected patients, and providers. Data regarding the patient referral process (organizational processes for referring patients to SMAs) and suggested improvements were collected to further inform the development of SMA implementation best practices. Providers from all three sites reported similar knowledge, attitude and beliefs of SMAs. In general, providers reported that the multi-disciplinary structure of SMAs was an effective strategy towards improving clinical outcomes for patients. Emergent themes regarding experiences with SMAs included improved self-efficacy gained from real-time collaboration with providers from multiple disciplines, perceived decrease in patient re-hospitalizations, and promotion of self-management skills for patients with HF. Most providers reported that the SMA-setting facilitated patient learning by providing opportunities for the sharing of experiences and knowledge. This was associated with the perception of increased comradery and support among patients. Future research is needed to test suggested improvements and to develop best practices for training additional sites to implement HF SMA.
共病门诊 (SMA) 为向患者提供慢性病管理所需的知识和技能提供了一种手段。然而，SMA 需要医疗保健提供者投入时间和注意力，他们必须从患者和提供者的角度理解 SMA 的目标和潜在好处。为了更好地了解如何获得提供者的参与并为未来的 SMA 实施提供信息，我们探索了基于知识-态度-实践模型的提供者经验的定性研究。在三家退伍军人事务医疗中心，对 24 名领导心力衰竭 SMA 的医疗保健提供者进行了半结构式访谈。采用了快速矩阵分析过程技术，包括基于团队的定性研究，然后是利益相关者验证。访谈指南遵循知识-态度-实践模型，具有 SMA 结构和内容的知识（了解 SMA 的结构）、SMA 态度/信念（对 SMA 使用的一般期望）、关于领导 SMA 如何影响患者的态度，以及提供者。还收集了关于患者转诊过程（将患者转介到 SMA 的组织流程）和建议改进的相关数据，以进一步为 SMA 实施最佳实践的制定提供信息。来自三个地点的提供者都报告了类似的 SMA 知识、态度和信念。一般来说，提供者报告称，SMA 的多学科结构是改善患者临床结果的有效策略。关于 SMA 经验的主题包括与来自多个学科的提供者实时协作获得的自我效能感提高、患者再住院率降低以及促进 HF 患者自我管理技能的提高。大多数提供者报告称，SMA 环境通过提供分享经验和知识的机会，促进了患者的学习。这与患者之间的团结和支持的感知增加有关。需要进一步的研究来测试建议的改进，并为培训其他地点实施 HF SMA 制定最佳实践。
