一项关于农村医疗服务提供者对医疗服务获取的社会、文化和项目障碍的看法的定性研究。
A qualitative study of rural healthcare providers' views of social, cultural, and programmatic barriers to healthcare access.
机构信息
School of Public & Community Health Sciences, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA.
Department of Psychology, University of Montana, 32 Campus Dr, Missoula, MT, 59812, USA.
出版信息
BMC Health Serv Res. 2022 Apr 2;22(1):438. doi: 10.1186/s12913-022-07829-2.
BACKGROUND
Ensuring access to healthcare is a complex, multi-dimensional health challenge. Since the inception of the coronavirus pandemic, this challenge is more pressing. Some dimensions of access are difficult to quantify, namely characteristics that influence healthcare services to be both acceptable and appropriate. These link to a patient's acceptance of services that they are to receive and ensuring appropriate fit between services and a patient's specific healthcare needs. These dimensions of access are particularly evident in rural health systems where additional structural barriers make accessing healthcare more difficult. Thus, it is important to examine healthcare access barriers in rural-specific areas to understand their origin and implications for resolution.
METHODS
We used qualitative methods and a convenience sample of healthcare providers who currently practice in the rural US state of Montana. Our sample included 12 healthcare providers from diverse training backgrounds and specialties. All were decision-makers in the development or revision of patients' treatment plans. Semi-structured interviews and content analysis were used to explore barriers-appropriateness and acceptability-to healthcare access in their patient populations. Our analysis was both deductive and inductive and focused on three analytic domains: cultural considerations, patient-provider communication, and provider-provider communication. Member checks ensured credibility and trustworthiness of our findings.
RESULTS
Five key themes emerged from analysis: 1) a friction exists between aspects of patients' rural identities and healthcare systems; 2) facilitating access to healthcare requires application of and respect for cultural differences; 3) communication between healthcare providers is systematically fragmented; 4) time and resource constraints disproportionately harm rural health systems; and 5) profits are prioritized over addressing barriers to healthcare access in the US.
CONCLUSIONS
Inadequate access to healthcare is an issue in the US, particularly in rural areas. Rural healthcare consumers compose a hard-to-reach patient population. Too few providers exist to meet population health needs, and fragmented communication impairs rural health systems' ability to function. These issues exacerbate the difficulty of ensuring acceptable and appropriate delivery of healthcare services, which compound all other barriers to healthcare access for rural residents. Each dimension of access must be monitored to improve patient experiences and outcomes for rural Americans.
背景
确保获得医疗保健是一个复杂的、多维度的健康挑战。自冠状病毒大流行开始以来，这一挑战变得更加紧迫。一些获得医疗保健的维度难以量化，即影响医疗服务被接受和适当性的特征。这些特征与患者对他们将要接受的服务的接受程度有关，并确保服务与患者特定的医疗保健需求之间的适当契合。在农村卫生系统中，这些获得医疗保健的维度尤为明显，因为额外的结构性障碍使得获得医疗保健更加困难。因此，重要的是要研究农村地区的医疗保健获取障碍，以了解其根源及其对解决问题的影响。
方法
我们使用定性方法和美国蒙大拿州农村地区的医疗保健提供者的便利样本。我们的样本包括 12 名来自不同培训背景和专业的医疗保健提供者。他们都是制定或修订患者治疗计划的决策者。我们使用半结构化访谈和内容分析来探讨他们患者群体中获得医疗保健的障碍——适当性和可接受性。我们的分析既有演绎法又有归纳法，重点关注三个分析领域：文化因素、医患沟通和医患沟通。成员检查确保了我们研究结果的可信度和可靠性。
结果
从分析中得出了五个关键主题：1）患者农村身份和医疗保健系统之间存在摩擦；2）促进获得医疗保健需要应用和尊重文化差异；3）医疗保健提供者之间的沟通系统地碎片化；4）时间和资源的限制对农村卫生系统造成了不成比例的伤害；5）利润优先于解决美国医疗保健获取障碍。
结论
在美国，特别是在农村地区，医疗保健的可及性不足是一个问题。农村医疗保健消费者构成了一个难以接触到的患者群体。满足人口健康需求的提供者太少，而碎片化的沟通则削弱了农村卫生系统的运作能力。这些问题加剧了确保农村居民获得可接受和适当医疗服务的难度，使农村居民获得医疗保健的所有其他障碍更加复杂。必须监测获得医疗保健的每个维度，以改善农村美国人的患者体验和结果。
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