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卡塔尔基层医疗中心卫生专业人员间开展协作的促进因素和阻碍因素:运用“Gears”模型进行的定性探索。

Facilitators and barriers to interprofessional collaboration among health professionals in primary healthcare centers in Qatar: a qualitative exploration using the "Gears" model.

机构信息

Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.

Hamad Medical Cooperation, Doha, Qatar.

出版信息

BMC Prim Care. 2024 Aug 27;25(1):316. doi: 10.1186/s12875-024-02537-8.

Abstract

BACKGROUND

The number of patients seeking medical care is increasing, necessitating more access to primary healthcare services. As several of these patients usually present with complex medical conditions, the need for interprofessional collaboration (IPC) among health professionals in primary care is necessary. IPC is essential for facing the increasing and challenging healthcare demands. Therefore, the facilitators of and the barriers to IPC should be studied in the hope that the results will be used to promote such endeavors.

OBJECTIVES

This study aimed to explore the perspectives of different health professionals regarding the facilitators of and the barriers to IPC in the primary healthcare settings in Qatar.

METHODS

A qualitative study using focus groups was conducted within the Primary Health Care Corporation (PHCC) in Qatar. Several health professionals were invited to participate in the focus groups. The focus groups were uniprofessional for general practitioners (GPs), nurses, and dentists, while they were interprofessional for the other health professionals. Focus groups were audio-recorded and transcribed verbatim and validated by the research team. The data were analyzed by deductive thematic analysis using the "Gears" Conceptual Model as a coding framework.

RESULTS

Fourteen focus groups were conducted involving 58 participants (including 17 GPs, 12 nurses, 15 pharmacists, 3 dentists, and 11 allied health professionals) working in PHCC in Qatar. The findings revealed a spectrum of factors influencing IPC, categorized into four main domains: Macro, Meso, Micro, and individual levels, with each accompanied by relevant barriers and facilitators. Key challenges identified included a lack of communication skills, insufficient professional competencies, and power imbalances, among others. To address these challenges, recommendations were made to implement dedicated training sessions on IPC, reduce hierarchical barriers among different health professionals, and enhance the effectiveness of existing systems. Conversely, it was emphasized that projects and campaigns focused on IPC, alongside the development of enhanced communication skills and the presence of supportive leadership, as essential for facilitating effective IPC in PHCCs.

CONCLUSION

The interplay between the meso, macro, micro, and individual levels highlight the significance of a multifaceted approach to interventions, aiming to enhance the successes of IPC. While initiatives like interprofessional education training are underway, numerous challenges persist before achieving improved collaboration and more efficient integration of IPC in the PHCC setting.

摘要

背景

寻求医疗服务的患者人数不断增加,这就需要更多的基本医疗服务。由于这些患者中许多人通常患有复杂的医疗状况,因此基本医疗保健服务中的卫生专业人员需要进行跨专业协作(IPC)。IPC 对于应对日益增长的具有挑战性的医疗保健需求至关重要。因此,应该研究 IPC 的促进因素和障碍,希望研究结果能够用于促进此类工作。

目的

本研究旨在探讨卡塔尔基本医疗保健机构中不同卫生专业人员对 IPC 促进因素和障碍的看法。

方法

在卡塔尔初级保健公司(PHCC)内使用焦点小组进行了一项定性研究。邀请了一些卫生专业人员参加焦点小组。针对全科医生(GP)、护士和牙医,焦点小组是单一专业的,而对于其他卫生专业人员,焦点小组是跨专业的。焦点小组进行了录音,并逐字记录下来,由研究团队进行了验证。使用“齿轮”概念模型作为编码框架,通过演绎主题分析对数据进行了分析。

结果

在卡塔尔 PHCC 进行了 14 次焦点小组,共涉及 58 名参与者(包括 17 名全科医生、12 名护士、15 名药剂师、3 名牙医和 11 名辅助卫生专业人员)。研究结果揭示了影响 IPC 的一系列因素,分为四个主要领域:宏观、中观、微观和个体水平,每个领域都有相关的障碍和促进因素。确定的主要挑战包括沟通技巧不足、专业能力不足、权力不平衡等。为了应对这些挑战,建议实施 IPC 专项培训课程,减少不同卫生专业人员之间的层级障碍,以及增强现有系统的有效性。相反,强调专注于 IPC 的项目和活动,以及增强沟通技巧和支持性领导的存在,对于促进 PHCC 中的有效 IPC 至关重要。

结论

中观、宏观、微观和个体水平之间的相互作用突出了采取多方面方法干预的重要性,旨在提高 IPC 的成功率。虽然正在进行跨专业教育培训等举措,但在实现改善协作和更有效地整合 IPC 之前,仍存在许多挑战。

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