Centre for Global Health, School of Public Health, Zhejiang University, Hangzhou, China.
Institute of Oncology, Affiliated Tumour Hospital of Nantong University, Nantong, China.
Age Ageing. 2024 Oct 1;53(10). doi: 10.1093/ageing/afae213.
Continuity of care is essential to older patients' health outcomes, especially for those with complex needs. It is a key function of primary healthcare. Despite China's policy efforts to promote continuity of care and an integrated healthcare system, primary healthcare centres (PHCs) are generally very underused.
To explore the experience and perception of continuity of care in older cancer patients, and to examine how PHCs play a role in the continuity of care within the healthcare system in China.
A qualitative study using semi-structured interviews was conducted in two tertiary hospitals in Nantong city, Jiangsu province, China. A combination of deductive and inductive analysis was conducted thematically.
Interviews with 29 patients highlighted three key themes: no guidance for patients in connecting with different levels of doctors, unmet patients' needs under specialist-led follow-up care, and poor coordination and communication across healthcare levels. This study clearly illustrated patients' lack of personal awareness and experience of care continuity, a key issue despite China's drive for an integrated healthcare system.
The need for continuity of care at each stage of cancer care is largely unmeasured in the current healthcare system for older patients. PHCs offer benefits which include convenience, less burdened doctors with more time, and lower out-of-pocket payment compared to tertiary hospitals, especially for patients with long-term healthcare needs. However, addressing barriers such as the absence of integrated medical records and unclear roles of PHCs are needed to improve the crucial role of PHCs in continuity of care.
医疗连续性对于老年患者的健康结果至关重要，特别是对于那些有复杂需求的患者。它是初级保健的关键功能。尽管中国有政策努力来促进医疗连续性和整合医疗体系，但初级保健中心（PHC）的利用率通常非常低。
探索老年癌症患者在医疗连续性方面的体验和看法，并研究 PHC 在医疗体系中如何发挥作用以实现连续性医疗。
在中国江苏省南通市的两家三级医院进行了一项定性研究，采用半结构式访谈。采用演绎和归纳分析相结合的方法进行主题分析。
对 29 名患者的访谈突出了三个关键主题：患者在与不同级别的医生连接方面没有指导，专科主导的随访护理无法满足患者的需求，以及医疗水平之间的协调和沟通不畅。这项研究清楚地说明了患者在医疗连续性方面缺乏个人意识和经验，尽管中国推动了整合医疗体系，但这是一个关键问题。
在当前针对老年患者的医疗体系中，癌症治疗各阶段连续性医疗的需求在很大程度上未得到衡量。PHC 提供了便利、医生有更多时间、患者自付费用更低等益处，与三级医院相比，特别是对于有长期医疗需求的患者。然而，需要解决整合医疗记录缺失和 PHC 角色不明确等障碍，以提高 PHC 在连续性医疗中的关键作用。
