Austrian National Public Health Institute, Addiction Competence Centre, Stubenring 6, 1010, Vienna, Austria.
Austrian National Public Health Institute, Competence Centre on Climate and Health, Stubenring 6, 1010, Vienna, Austria.
BMC Health Serv Res. 2022 Aug 14;22(1):1037. doi: 10.1186/s12913-022-08426-z.
There is a growing interest in redesigning healthcare systems to increase access to and coordination across care settings for people with chronic conditions. We aim to gain a better understanding of the barriers faced by (1) children with chronic bronchial asthma, (2) adults with non-specific chronic back pain, and (3) older people with pre-existing mental illness/es in Austria's fragmented social health insurance system.
Using a qualitative design, we conducted semi-structured interviews face-to-face and by telephone with health service providers, researchers, experts by experience (persons with lived/ personal experience, i.e., service users, patient advocates or family members/carers), and employees in public health administration between July and October 2019. The analysis and interpretation of data were guided by Levesque's model of access, a conceptual framework used to evaluate access broadly according to different dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability, and appropriateness.
The findings from the 25 expert interviews were organised within Levesque's conceptual framework. They highlight a lack of coordination and defined patient pathways, particularly at the onset of the condition, when seeking a diagnosis, and throughout the care process. On the supply side, patterns of poor patient-provider communication, lack of a holistic therapeutic approach, an urban-rural divide, strict separation between social care and the healthcare system and limited consultation time were among the barriers identified. On the demand side, patients' ability to perceive a need and to subsequently seek and reach healthcare services was an important barrier, closely linked to a patient's socio-economic status, health literacy and ability to pay.
While studies on unmet needs suggest a very low level of barriers to accessing health care in the Austrian context, our study highlights potential 'invisible' barriers. Barriers to healthcare access are of concern for patients with chronic conditions, underlining existing findings about the need to improve health services according to patients' specific needs. Research on how to structure timely and integrated care independent of social and economic resources, continuity of care, and significant improvements in patient-centred communication and coordination of care would be paramount.
人们越来越关注重新设计医疗保健系统，以增加患有慢性病的人群在不同医疗保健环境之间的可及性和协调性。我们旨在更深入地了解奥地利碎片化的社会健康保险体系下，（1）患有慢性支气管哮喘的儿童、（2）患有非特异性慢性腰痛的成年人和（3）患有先前存在的精神疾病/障碍的老年人所面临的障碍。
采用定性设计，我们于 2019 年 7 月至 10 月期间，与卫生服务提供者、研究人员、经验专家（有过实际生活/个人经历的人，即服务使用者、患者倡导者或家庭成员/照顾者）以及公共卫生行政部门的员工进行了面对面和电话方式的半结构化访谈。数据分析和解释遵循莱韦斯克的可及性模型，这是一个用于根据护理的不同可及性维度（可接近性、可接受性、可获得性和适应性、可负担性和适宜性）广泛评估可及性的概念框架。
25 名专家访谈的结果按照莱韦斯克的概念框架进行了组织。研究结果突出了协调和明确的患者路径的缺乏，特别是在疾病开始时、寻求诊断时以及整个护理过程中。在供应方面，患者与提供者之间沟通不良、缺乏整体治疗方法、城乡差距、社会关怀与医疗保健系统的严格分离以及咨询时间有限等模式被确定为障碍。在需求方面，患者感知需求以及随后寻求和获得医疗保健服务的能力是一个重要的障碍，这与患者的社会经济地位、健康素养和支付能力密切相关。
尽管关于未满足需求的研究表明在奥地利背景下获得医疗保健的障碍非常低，但我们的研究强调了潜在的“无形”障碍。医疗保健可及性的障碍令慢性疾病患者感到担忧，强调了根据患者的具体需求改善卫生服务的必要性。关于如何在不依赖社会和经济资源的情况下构建及时和综合的护理、连续性护理以及显著改善以患者为中心的沟通和护理协调的研究至关重要。
