Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada.
Peking University Sixth Hospital, Peking University Institute of Mental Health, National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), NHC Key Laboratory of Mental Health (Peking University), Beijing, 100191, China.
BMC Psychiatry. 2022 May 5;22(1):321. doi: 10.1186/s12888-022-03955-7.
The shared care pathway for ADHD is a program developed in Canada with two main strategies: (a) implement a shared care pathway between general practitioners (GPs) and specialists, and (b) step up or down care so that the patient is treated at the most appropriate level of care, depending on the complexity or outcome of their illness. The current study aims to identify the challenges and facilitators of implementing this program in a Chinese mental health service setting.
Two focus groups were conducted using semi-structured interviews with a total of 7 health care providers in Beijing. An adapted grounded theory methodology using open-ended, axial and selective coding was used for data analysis.
We identified three main levels related to barriers and facilitators: (1) a sociocultural level of patients' and health care providers' perspectives; (2) a structural level related to internal and external organizational environments; (3) and the level of the intervention itself with its characteristics. The project is generally aligned with the mandates and goals of the health system, but two of the main obstacles are the varying qualifications of physicians in hospitals of different levels, implying different needs and flexible and adapted training programs, and the lack of appropriate patient referral systems between the different hospital levels.
Our study highlights the importance of consultation to obtain a "lay of the land" for deciding on the implementation steps of an a priori well accepted model of care.
注意力缺陷多动障碍（ADHD）共病管理路径是在加拿大开发的一个项目，其具有两个主要策略：（a）在全科医生（GP）和专家之间实施共病管理路径；（b）根据患者疾病的复杂性或结果，调整或增加护理级别，使患者在最合适的护理级别接受治疗。本研究旨在确定在中国精神卫生服务环境中实施该项目的挑战和促进因素。
在北京的 7 名卫生保健提供者中进行了 2 次焦点小组讨论，采用半结构化访谈，使用开放式、轴向和选择性编码进行数据分析。
我们确定了与障碍和促进因素相关的三个主要层面：（1）患者和卫生保健提供者观点的社会文化层面；（2）与内部和外部组织环境相关的结构层面；（3）干预本身及其特征的层面。该项目通常符合卫生系统的任务和目标，但有两个主要障碍，一是不同级别医院医生的资质不同，需要不同的培训内容和灵活的适应性培训计划；二是不同医院级别之间缺乏适当的患者转诊系统。
我们的研究强调了咨询的重要性，以了解情况，确定预先接受的护理模式的实施步骤。
