Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco.
Department of Humanities and Social Sciences, University of California, San Francisco.
JAMA Netw Open. 2023 Sep 5;6(9):e2336030. doi: 10.1001/jamanetworkopen.2023.36030.
Although the barriers to dementia care in primary care are well characterized, primary care practitioner (PCP) perspectives could be used to support the design of values-aligned dementia care pathways that strengthen the role of primary care.
To describe PCP perspectives on their role in dementia diagnosis and care.
DESIGN, SETTING, AND PARTICIPATION: In this qualitative study, interviews were conducted with 39 PCPs (medical doctors, nurse practitioners, and doctors of osteopathic medicine) in California between March 2020 and November 2022. Results were analyzed using thematic analysis.
Overarching themes associated with PCP roles in dementia care.
Interviews were conducted with 39 PCPs (25 [64.1%] were female; 16 [41%] were Asian). The majority (36 PCPs [92.3%]) reported that more than half of their patients were insured via MediCal, the California Medicaid program serving low-income individuals. Six themes were identified that convey PCPs' perspectives on their role in dementia care. These themes focused on (1) their role as first point of contact and in the diagnostic workup; (2) the importance of long-term, trusting relationships with patients; (3) the value of understanding patients' life contexts; (4) their work to involve and educate families; (5) their activities around coordinating dementia care; and (6) how the care they want to provide may be limited by systems-level constraints.
In this qualitative study of PCP perspectives on their role in dementia care, there was alignment between PCP perspectives about the core values of primary care and their work diagnosing and providing care for people living with dementia. The study also identified a mismatch between these values and the health systems infrastructure for dementia care in their practice environment.
尽管初级保健中痴呆症护理的障碍已得到充分描述，但初级保健医生（PCP）的观点可用于支持设计符合价值观的痴呆症护理途径，从而加强初级保健的作用。
描述 PCP 对其在痴呆症诊断和护理中的作用的看法。
设计、地点和参与者：在这项定性研究中，2020 年 3 月至 2022 年 11 月期间，在加利福尼亚州对 39 名 PCP（医生、执业护士和骨科医生）进行了访谈。使用主题分析对结果进行了分析。
与 PCP 在痴呆症护理中的角色相关的总体主题。
对 39 名 PCP 进行了访谈（25 名[64.1%]为女性；16 名[41%]为亚洲人）。大多数（36 名 PCP [92.3%]）报告说，他们的一半以上患者通过 MediCal 投保，MediCal 是为低收入个人提供服务的加利福尼亚州医疗补助计划。确定了六个主题，这些主题传达了 PCP 对其在痴呆症护理中的角色的看法。这些主题侧重于（1）他们作为第一接触点和诊断工作的角色；（2）与患者建立长期、信任关系的重要性；（3）了解患者生活背景的价值；（4）他们参与和教育家庭的工作；（5）他们协调痴呆症护理的活动；以及（6）他们希望提供的护理可能受到系统层面限制的影响。
在这项关于 PCP 对其在痴呆症护理中的角色的看法的定性研究中，PCP 对初级保健核心价值观及其诊断和为痴呆症患者提供护理工作的看法是一致的。该研究还发现，在他们的实践环境中，这些价值观与痴呆症护理的卫生系统基础设施之间存在不匹配。
