Potter Lucy C, Stone Tracey, Swede Julie, Connell Florrie, Cramer Helen, McGeown Helen, Carvalho Maria, Horwood Jeremy, Feder Gene, Farr Michelle, Gaps Bridging
Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol.
Centre for Academic Primary Care, Bristol Medical School, University of Bristol; National Institute for Health and Care Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol.
Br J Gen Pract. 2024 Apr 25;74(742):e330-e338. doi: 10.3399/BJGP.2023.0244. Print 2024 May.
People with severe and multiple disadvantage (SMD) who experience combinations of homelessness, substance misuse, violence, abuse, and poor mental health have high health needs and poor access to primary care.
To improve access to general practice for people with SMD by facilitating collaborative service improvement meetings between healthcare staff, people with lived experience of SMD, and those who support them; participants were then interviewed about this work.
The Bridging Gaps group is a collaboration between healthcare staff, researchers, women with lived experience of SMD, and a charity that supports them in a UK city. A project was co-produced by the Bridging Gaps group to improve access to general practice for people with SMD, which was further developed with three inner-city general practices.
Nine service improvement meetings were facilitated at three general practices, and six of these were formally observed. Nine practice staff and four women with lived experience of SMD were interviewed. Three women with lived experience of SMD and one staff member who supports them participated in a focus group. Data were analysed inductively and deductively using thematic analysis.
By providing time and funding opportunities to motivated general practice staff and involving participants with lived experience of SMD, service changes were made in an effort to improve access for people with SMD. These included prioritising patients on an inclusion patient list with more flexible access, providing continuity for patients via a care coordinator and micro-team of clinicians, and developing an information-sharing document. The process and outcomes improved connections within and between general practices, support organisations, and people with SMD.
The co-designed strategies described in this study could be adapted locally and evaluated in other areas. Investing in this focused way of working may improve accessibility to health care, health equity, and staff wellbeing.
患有严重多重不利因素（SMD）的人群，即同时经历无家可归、药物滥用、暴力、虐待和心理健康问题的人，有很高的健康需求，但获得初级医疗服务的机会却很差。
通过促进医护人员、有SMD生活经历的人和支持他们的人之间的协作服务改进会议，改善SMD患者获得全科医疗服务的机会；然后对参与者进行关于这项工作的访谈。
“弥合差距”小组是医护人员、研究人员、有SMD生活经历的女性以及在英国一个城市支持她们的慈善机构之间的合作。“弥合差距”小组共同开展了一个项目，以改善SMD患者获得全科医疗服务的机会，并与三个市中心的全科诊所进一步合作。
在三个全科诊所组织了九次服务改进会议，其中六次进行了正式观察。对九名诊所工作人员和四名有SMD生活经历的女性进行了访谈。三名有SMD生活经历的女性和一名支持她们的工作人员参加了焦点小组。使用主题分析法对数据进行归纳和演绎分析。
通过为积极主动的全科诊所工作人员提供时间和资金机会，并让有SMD生活经历的参与者参与进来，做出了服务改变，以努力改善SMD患者的就医机会。这些改变包括在包容性患者名单上对患者进行优先排序，提供更灵活的就医途径，通过护理协调员和临床医生微型团队为患者提供连续性服务，以及制定一份信息共享文件。这个过程和结果改善了全科诊所、支持组织和SMD患者内部以及彼此之间的联系。
本研究中描述的共同设计策略可以在当地进行调整，并在其他地区进行评估。以这种有针对性的工作方式进行投资可能会改善医疗服务的可及性、健康公平性和工作人员的幸福感。
