Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):3043. doi: 10.1370/afm.20.s1.3043.
Context: There is great interest in intensive primary care (IPC) interventions to address the needs of medically and socially complex patients, however it is unknown how these interventions impact patient experience. Objective: Describe the experience of patients on the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an IPC for patients with complex needs at a federally qualified health center serving patients with high rates of homelessness. Study Design: Qualitative study using semi-structured interviews with 25 patients enrolled in the SUMMIT intervention. We conducted a thematic analysis using a hybrid inductive/deductive approach. Results: Prior to SUMMIT, patients often felt it was difficult to engage with the healthcare system, in part due to their complex medical conditions, but also factors including prior trauma, poverty, substance use, and providers' stigma. We identified four themes related to how and why patients felt SUMMIT improved their care: 1) Investment: Patients perceived the team as truly invested in them and expressed how the team walked side by side in their care journeys to overcome stigma, low-self efficacy, and prior negative experiences with the healthcare system 2) Family: Patients reported feeling a strong sense of family with SUMMIT team members and believed that the team had genuine duty and obligation toward them, interacting with them in a non-judgmental, culturally competent manner. 3) Feeling valued: Patients expressed that the team's flexible design, continuity of team membership, care coordination and addressing unmet needs and social determinants led them to feel valued and hope. 4) Evolution of self-efficacy: Patients experienced improved self-efficacy, and were able to engage with health care proactively, instead of avoiding care. Conclusion: Medically and socially complex patients experience trauma and stigma that shape perceptions of care. Patients appreciated humanizing interactions with team members along with the additional support SUMMIT provided to overcome barriers to care. They spoke of the team as family members who valued them and they recognized how the program had helped them take a more active role in improving their own health. Our findings suggest that effectiveness of IPC interventions may lie, in part, on the use of team members who have the skills and commitment to deliver non-judgemental, culturally competent, longitudinal relationship-focused care.
强化初级保健（IPC）干预措施受到了极大关注，以满足医疗和社会复杂患者的需求，但尚不清楚这些干预措施如何影响患者体验。目的：描述在联邦合格健康中心为高流浪率患者服务的复杂需求患者中实施的简化统一有意义管理的跨学科团队（SUMMIT）IPC 中患者的体验。研究设计：使用半结构式访谈对 25 名参与 SUMMIT 干预的患者进行定性研究。我们采用混合归纳/演绎方法进行主题分析。结果：在 SUMMIT 之前，患者常常感到难以与医疗保健系统互动，部分原因是他们的复杂医疗状况，但也包括先前的创伤、贫困、药物使用以及提供者的污名化等因素。我们确定了四个与患者如何以及为何认为 SUMMIT 改善其护理相关的主题：1）投资：患者认为团队真正地投资于他们，并表达了团队如何在他们的护理旅程中并肩前行，以克服污名化、低自我效能感和以前对医疗保健系统的负面体验。2）家庭：患者报告与 SUMMIT 团队成员有强烈的家庭感，并认为团队对他们有真正的责任和义务，以非评判、文化上合适的方式与他们互动。3）感到被重视：患者表示，团队灵活的设计、团队成员的连续性、护理协调以及满足未满足的需求和社会决定因素，使他们感到被重视和充满希望。4）自我效能感的提升：患者经历了自我效能感的提升，并能够积极主动地参与医疗保健，而不是避免医疗保健。结论：医疗和社会复杂的患者经历了创伤和污名化，这些经历塑造了他们对护理的看法。患者欣赏与团队成员的人性化互动，以及 SUMMIT 提供的额外支持，以克服护理障碍。他们将团队成员视为重视他们的家庭成员，并认识到该计划如何帮助他们在改善自身健康方面发挥更积极的作用。我们的研究结果表明，IPC 干预措施的有效性可能部分在于团队成员是否具备提供非评判、文化上合适、纵向关系为重点的护理的技能和承诺。
