儿科医生和儿童青少年精神病学家对新兴成年人协调护理的看法。
Pediatrician and Child Adolescent Psychiatrist Perspectives of Coordinated Care for Emerging Adults.
机构信息
Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
出版信息
J Adolesc Health. 2023 May;72(5):770-778. doi: 10.1016/j.jadohealth.2022.12.002. Epub 2023 Jan 3.
PURPOSE
To explore pediatrician and child/adolescent psychiatrists' perspectives of the role of coordinated care for emerging adults with serious mental health conditions, particularly as they transition to adult care.
METHODS
Semi-structured individual interviews of a purposive sample of 10 pediatricians and 11 child/adolescent psychiatrists in Massachusetts were used to explore coordinated care for emerging adults. Following verbatim transcription and double coding, we conducted a thematic analysis to identify key themes. Care coordination concepts explored included a case discussion, teamwork, communication methods, medication management, transition to adult care, the healthcare home, and youth and family role. Organizational and societal barriers were also discussed.
RESULTS
Providers described key barriers to continuous, coordinated care for youth with serious mental health conditions, including poor communication systems between providers, no organized process for the transition from pediatric to adult care, state licensing laws (particularly impacting college-age youth), inadequate connection to community supports, and poor reimbursement rates for psychiatric care. Termination of primary care in young adults and inadequate medication side effect monitoring were described as key gaps in care.
DISCUSSION
The current system of coordinated care for emerging adults with serious mental health conditions is a perfect storm of challenges that creates a vicious cycle of interconnected barriers which lead to fragmented, discontinuous, and sub-par care for this population.
目的
探讨儿科医生和儿童/青少年精神科医生对患有严重精神疾病的成年初期患者协调护理角色的看法，特别是在他们过渡到成人护理时。
方法
采用马萨诸塞州的 10 名儿科医生和 11 名儿童/青少年精神科医生的有针对性的样本进行半结构式个人访谈，以探讨成年初期患者的协调护理。在进行逐字转录和双重编码后，我们进行了主题分析以确定关键主题。探讨的协调护理概念包括病例讨论、团队合作、沟通方法、药物管理、向成人护理过渡、医疗之家以及青年和家庭角色。还讨论了组织和社会障碍。
结果
提供者描述了为患有严重精神健康状况的青年提供持续、协调护理的主要障碍，包括提供者之间沟通系统不佳、没有从儿科到成人护理的过渡组织过程、州许可法（特别是影响大学生年龄的青年）、与社区支持的连接不足以及对精神科护理的报销率低。在年轻人中终止初级保健和药物副作用监测不足被描述为护理的主要差距。
讨论
当前严重精神疾病成年初期患者协调护理的系统是一系列挑战的完美风暴，这些挑战导致了相互关联的障碍的恶性循环，从而导致了该人群的碎片化、不连续和低于标准的护理。
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