Policy Research Unit Behavioural Science, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley Clark Building, Richardson Road, NE1 4AX, Newcastle upon Tyne, UK.
Research & Evidence Team, NECS, Riverside House, Goldcrest Way, NE15 8NY, Newcastle upon Tyne, UK.
BMC Prim Care. 2022 Jul 20;23(1):180. doi: 10.1186/s12875-022-01790-z.
Shared medical appointments (SMAs) or group consultations have been promoted in primary care to improve workload pressures, resource-use efficiency and patient self-management of long-term conditions (LTCs). However, few studies have explored stakeholders' perspectives of this novel care delivery model in the English NHS context, particularly patients' views and experiences of SMAs.
Semi-structured interviews were used to explore the perspectives of stakeholders (21 patients, 17 primary care staff, 2 commissioners and 2 SMA training providers) with and without SMA experience from a range of geographical and socio-economic backgrounds in the North East and North Cumbrian region of England. Thematic analysis was conducted to examine perceptions around impact on patient care and outcomes and barriers and facilitators to implementation.
Three main themes were identified: 'Value of sharing', 'Appropriateness of group setting', 'Implementation processes'. Patients experiences and perceptions of SMAs were largely positive yet several reported reservations about sharing personal information, particularly in close-knit communities where the risk of breaching confidentiality was perceived to be greater. SMAs were considered by patients and staff to be inappropriate for certain personal conditions or for some patient groups. Staff reported difficulties engaging sufficient numbers of patients to make them viable and having the resources to plan and set them up in practice. Whilst patients and staff anticipated that SMAs could deliver high quality care more efficiently than 1:1 appointments, none of the practices had evaluated the impact SMAs had on patient health outcomes or staff time.
Stakeholder experiences of SMA use in English primary care are largely similar to those reported in other countries. However, several important cultural barriers were identified in this setting. Further work is needed to better understand how patient and staff perceptions, experiences and engagement with SMAs change with regular use over time. Concerns regarding staff capacity, additional resource requirements and numbers of eligible patients per practice suggest SMAs may only be feasible in some smaller practices if facilitated by primary care networks. Further mixed-method evaluations of SMAs are needed to inform the evidence base regarding the effectiveness, efficiency and feasibility of SMAs long-term and subsequently their wider roll-out in English primary care.
在初级保健中推广共设医疗预约（Shared medical appointments，SMAs）或小组咨询，以改善工作负荷压力、资源利用效率和慢性病患者的自我管理。然而，在英国国民保健制度（NHS）背景下，很少有研究探讨利益相关者对这种新型护理模式的看法，特别是患者对 SMA 的看法和体验。
使用半结构化访谈，从英格兰东北部和北坎布里亚地区的不同地理位置和社会经济背景中，调查有和没有 SMA 经验的利益相关者（21 名患者、17 名初级保健工作人员、2 名专员和 2 名 SMA 培训提供者）的观点。采用主题分析来检查对患者护理和结果的影响以及实施的障碍和促进因素的看法。
确定了三个主要主题：“共享的价值”、“小组设置的适当性”、“实施过程”。患者对 SMA 的体验和看法大多是积极的，但也有一些人对分享个人信息表示保留，特别是在那些社区关系紧密、保密性风险被认为更高的地方。患者和工作人员认为 SMA 不适合某些个人情况或某些患者群体。工作人员报告说，很难让足够数量的患者参与进来，使 SMA 可行，并且在实践中也没有资源来计划和设置 SMA。虽然患者和工作人员预计 SMA 能够比 1:1 预约更高效地提供高质量的护理，但没有一家诊所评估 SMA 对患者健康结果或工作人员时间的影响。
英国初级保健中 SMA 使用的利益相关者体验与其他国家报告的基本相似。然而，在这种环境下，发现了一些重要的文化障碍。需要进一步研究，以更好地了解随着时间的推移，患者和工作人员对 SMA 的看法、体验和参与如何变化。对工作人员能力、额外资源需求和每个实践中符合条件的患者数量的关注表明，如果由初级保健网络协助，SMA 可能仅在一些较小的实践中可行。需要进一步对 SMA 进行混合方法评估，以提供关于 SMA 的长期有效性、效率和可行性的证据基础，随后在英国初级保健中更广泛地推广。
