Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland, UK.
School of Divinity, History, Philosophy and Art History, University of Aberdeen, Aberdeen, Scotland.
BMC Prim Care. 2023 Oct 19;24(1):212. doi: 10.1186/s12875-023-02168-5.
Two polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals' perspectives on CSP to inform future developments.
Qualitative research including 23 semi-structured interviews with 13 health professionals and 3 co-ordinators. Interpretive analysis, including considerations of how different understandings, enactments, experiences and evaluative judgements of CSP clustered across health professionals, and potential causal links between them.
Both polyclinic teams introduced CSP and sustained it through COVID-19 disruptions. The first examples health professionals gave of CSP 'going well' all involved patients who came prepared, motivated and able to modify behaviours to improve their biomedical markers, but health professionals also said that they only occasionally saw such patients in practice. Health professionals' accounts of how they conducted CSP conversations varied: some interpretations and reported enactments were less clearly aligned with the developers' person-centred aspirations than others. Health professionals brought different communication skill repertoires to their encounters and responded variably to challenges to CSP that arose from: the linguistic and educational diversity of patients in this polyclinic context; the cultural shift that CSP involved; workload pressures; organisational factors that limited relational and informational continuity of care; and policies promoting biomedical measures as key indicators of healthcare quality. While all participants saw potential in CSP, they differed in the extent to which they recognised relational and experiential benefits of CSP (beyond biomedical benefits), and their recommendations for continuing its use beyond the clinical trial were contingent on several considerations. Our analysis shows how narrower and broader interpretive emphases and initial skill repertoires can interact with situational challenges and respectively constrain or extend health professionals' ability to refine their skills with experiential learning, reduce or enhance the potential benefits of CSP, and erode or strengthen motivation to use CSP.
Health professionals' interpretations of CSP, along with their communication skills, interact in complex ways with other features of healthcare systems and diverse patient-circumstance scenarios. They warrant careful attention in efforts to implement and evaluate person-centred support for people with long-term conditions.
新加坡的两家诊所对系统进行了修改，并对卫生专业人员进行了培训，以便在临床试验中为糖尿病患者提供以患者为中心的护理和支持计划（CSP）。我们旨在调查卫生专业人员对 CSP 的看法，以为未来的发展提供信息。
定性研究包括对 13 名卫生专业人员和 3 名协调员进行的 23 次半结构化访谈。解释性分析，包括考虑 CSP 在卫生专业人员中的不同理解、实施、经验和评价判断如何聚类，以及它们之间潜在的因果联系。
两家诊所团队都引入了 CSP，并在 COVID-19 中断期间维持了 CSP。卫生专业人员第一次举例说明 CSP“进展顺利”的情况，都涉及到那些准备充分、有动力并有能力改变行为以改善其生物医学指标的患者，但卫生专业人员也表示，在实践中他们只是偶尔看到这样的患者。卫生专业人员对他们如何进行 CSP 对话的描述各不相同：一些解释和报告的实施与开发者以患者为中心的愿望不如其他人那样明确一致。卫生专业人员在与患者的接触中带来了不同的沟通技巧，并对 CSP 面临的挑战做出了不同的反应：在这种诊所环境中，患者的语言和教育多样性；CSP 所涉及的文化转变；工作量压力；限制护理关系和信息连续性的组织因素；以及促进生物医学措施作为医疗保健质量关键指标的政策。虽然所有参与者都看到了 CSP 的潜力，但他们对 CSP 的关系和体验益处（超出生物医学益处）的认识程度以及他们对在临床试验之外继续使用 CSP 的建议存在差异，这取决于几个因素。我们的分析表明，较窄和较宽的解释重点以及初始技能组合如何与情境挑战相互作用，从而分别限制或扩展卫生专业人员通过体验式学习来提高技能的能力、降低或提高 CSP 的潜在收益，并侵蚀或增强使用 CSP 的动机。
CSP 的解释以及他们的沟通技巧，与医疗保健系统的其他特征和多样化的患者情况场景以复杂的方式相互作用。在努力实施和评估针对慢性病患者的以患者为中心的支持时，需要对其进行仔细关注。
