Welke Samantha, Duncanson Emily, Bollen Chris, Britton Anne, Donnelly Fiona, Faull Randall, Kellie Andrew, Le Leu Richard, Manski-Nankervis Jo-Anne, McDonald Stephen, Richards Katherine, Whittington Tiffany, Yeoh Jackie, Jesudason Shilpanjali
Central Northern Adelaide Renal and Transplantation Service (CNARTS), Central Adelaide Local Health Network, Royal Adelaide Hospital, Adelaide, SA, Australia.
School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
J Nephrol. 2023 Sep;36(7):2023-2035. doi: 10.1007/s40620-023-01742-5. Epub 2023 Aug 26.
Clinicians and patients have reported fragmentation in the primary and tertiary healthcare interface. However, perspectives of service navigation and the impacts of fragmentation are not well defined, particularly for patients transitioning to dialysis. This study aimed to define patient perspectives of the functioning of the health service interface and impacts on healthcare experiences and engagement, informing patient-centred and outcomes-focused service models.
A qualitative study was conducted through semi-structured interviews with 25 dialysis patients (16 males) aged 34-78 receiving dialysis across a multi-site tertiary service. Transcripts were analysed thematically.
Three main themes were identified: (1) The Changing Nature of General Practitioner (GP) Patient Relationships; (2) Ownership and Leadership in Kidney Care; and (3) The Importance of Nephrologist-GP Communications. Patients perceived an unreliable primary-tertiary service interface which lacked coordinated care and created challenges for primary care continuity. These impacted perceptions of healthcare provider expertise and confidence in healthcare systems. Patients subsequently increased the healthcare sought from tertiary kidney clinicians. The fractured interface led some to coordinate communication between health sectors, to support care quality, but this caused additional stress.
A fragmented primary-tertiary healthcare interface creates challenges for patient service navigation and can negatively impact patient experiences, leading to primary care disengagement, reduced confidence in health care quality and increased stress. Future studies are imperative for assessing initiatives facilitating health system integration, including communication technologies, healthcare provider training, patient empowerment, and specific outcomes in health, economic and patient experience measures, for patients transitioning to dialysis.
临床医生和患者都报告了初级和三级医疗保健界面存在碎片化问题。然而，服务导航的观点以及碎片化的影响尚未得到明确界定，尤其是对于即将接受透析治疗的患者而言。本研究旨在明确患者对医疗服务界面功能的看法以及对医疗体验和参与度的影响，为以患者为中心和以结果为导向的服务模式提供依据。
通过对多站点三级服务机构中25名年龄在34 - 78岁之间接受透析治疗的患者（16名男性）进行半结构化访谈，开展了一项定性研究。对访谈记录进行了主题分析。
确定了三个主要主题：（1）全科医生（GP）与患者关系的变化性质；（2）肾脏护理中的自主权和领导力；（3）肾病专家与全科医生沟通的重要性。患者认为初级 - 三级服务界面不可靠，缺乏协调护理，给初级护理的连续性带来了挑战。这些影响了对医疗服务提供者专业知识的看法以及对医疗系统的信心。患者随后增加了向三级肾脏临床医生寻求的医疗服务。破碎的界面导致一些患者协调卫生部门之间的沟通，以支持护理质量，但这也带来了额外的压力。
初级 - 三级医疗保健界面的碎片化给患者的服务导航带来了挑战，并可能对患者体验产生负面影响，导致初级护理脱节、对医疗质量的信心降低以及压力增加。对于评估促进卫生系统整合的举措，包括通信技术、医疗服务提供者培训、患者赋权以及对即将接受透析治疗的患者在健康、经济和患者体验方面的具体成果，未来的研究势在必行。
