Burch Patrick, Whittaker William, Bower Peter, Checkland Katherine
Centre for Primary Care and Health Services Research, University of Manchester, Manchester.
Manchester Centre for Health Economics, University of Manchester, Manchester.
Br J Gen Pract. 2024 Apr 25;74(742):e300-e306. doi: 10.3399/BJGP.2023.0208. Print 2024 May.
There is an international trend towards the at-scale provision of primary care services, with such services often provided in different settings by a clinician unfamiliar to the patient. It is often assumed that, in the absence of relational continuity, any competent clinician can deliver joined-up, continuous care if they have access to clinical notes.
To explore the factors that affect the potential for providing joined-up, continuous care in a system where care is delivered away from a patient's regular practice, by a different organisation and set of staff.
Case studies of two extended-access providers in the north of England.
Case studies were carried out between September 2021 and January 2022 in two sites. Data collected included observations of patient-healthcare professional interactions, interviews with staff and patients, and documentation. Analysis took place using a constant comparison approach. Data were coded. A model of the factors affecting continuity was constructed.
The potential for joined-up, continuous care appears dependent on staff, patient, and system factors. This includes diverse elements such as the attitude of clinicians to care coordination and the ability of an organisation to retain staff.
Healthcare systems increasingly rely on the assumption that any competent clinician can deliver joined-up, continuous care if they have access to clinical notes. This appears not to be the case. This study presents a model of factors affecting the patient's experience of continuity. The model needs validating in in-hours general practice and other settings.
目前国际上存在大规模提供初级保健服务的趋势，此类服务通常由患者不熟悉的临床医生在不同场所提供。人们常常认为，在缺乏关系连续性的情况下，任何称职的临床医生只要能获取临床记录，就能提供连贯、持续的护理。
探讨在一个由不同组织和工作人员在患者常规医疗机构之外提供护理的系统中，影响提供连贯、持续护理可能性的因素。
对英格兰北部两家延长服务时间提供者的案例研究。
于2021年9月至2022年1月在两个地点开展案例研究。收集的数据包括对患者与医护人员互动的观察、对工作人员和患者的访谈以及文件资料。采用持续比较法进行分析。对数据进行编码。构建了一个影响连续性的因素模型。
提供连贯、持续护理的可能性似乎取决于工作人员、患者和系统因素。这包括诸如临床医生对护理协调的态度以及组织留住员工的能力等多种因素。
医疗系统越来越依赖这样一种假设，即任何称职的临床医生只要能获取临床记录，就能提供连贯、持续的护理。但实际情况似乎并非如此。本研究提出了一个影响患者连续性体验的因素模型。该模型需要在正常工作时间的全科医疗及其他环境中进行验证。
