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医疗保健专业人员如何在初级保健中应对有限的资源 - 一项访谈研究。

How health care professionals handle limited resources in primary care - an interview study.

机构信息

Department of Health, Medicine and Caring Sciences, Linköping University, Sandbäcksgatan 7, 581 83, Linköping, Sweden.

Department of Health, Medicine and Caring Sciences, Swedish National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden.

出版信息

BMC Health Serv Res. 2023 Jan 3;23(1):6. doi: 10.1186/s12913-022-08996-y.


DOI:10.1186/s12913-022-08996-y
PMID:36597086
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9808951/
Abstract

INTRODUCTION: Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice.  METHODS: Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. FINDINGS: Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients' healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals' competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. CONCLUSION: Priorities in primary care are not, "one fits all" solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professional's actions for how influx of patients' is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.

摘要

简介: 世界各地的医疗体系都面临着资源有限的问题,而这些资源与当前的医疗需求相比是远远不够的。一个可及的初级保健体系是为人口提供负担得起的医疗服务并减轻整个医疗体系压力(如不必要的住院治疗和相关费用)的重要解决方案的一部分。由于初级保健构成了医疗保健的重要第一线,因此确定优先事项并决定做什么以及为谁提供服务的任务主要在于初级保健专业人员。因此,初级保健专业人员的决策和行为在实现人口健康公平方面起着核心作用。本研究旨在探讨初级保健专业人员如何处理资源有限的情况,并增进我们对实践中优先事项的了解。 方法: 对 14 名在瑞典初级保健机构工作的医疗保健专业人员(7 名护士,7 名医生)进行了半结构化访谈。使用内容分析法对数据进行了归纳分析。 结果: 发现了三个主要类别:患者涌入;结构性条件;和行动。每个类别都说明了初级保健专业人员为实现良好和公平的护理所做的重要方面。患者涌入涉及专业人员处理患者医疗需求和患者行为的方面。结构性条件包括为初级保健设定的政策和目标、能力可用性、技术系统和组织文化。为了应对资源有限的情况,专业人员采取了不同的行动:将医疗保健需求与专业人员的能力相匹配,将护理需求定义为适合预约系统的预约,在不适当的医疗保健水平上提供护理,重新安排工作时间,并将决策传递下去。 结论: 初级保健的优先事项不是“一刀切”的解决方案。我们的研究表明,初级保健的优先事项包括持续的日常流程,这些流程根据情况、患者涌入的背景和结构性条件进行调整。医疗保健专业人员在处理与资源有限相关的患者涌入方面的行动是在这个背景下创建和形成的,这个背景也为他们的行动设定了界限。

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