提升加拿大以患者为中心的脊骨神经医学护理：通过定性需求评估识别障碍、促成因素和策略。

Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment.

机构信息

Canadian Memorial Chiropractic College, Toronto, ON, Canada.

Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.

出版信息

Chiropr Man Therap. 2024 Nov 28;32(1):37. doi: 10.1186/s12998-024-00560-1.

DOI:10.1186/s12998-024-00560-1

PMID:39609815

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11605932/

Abstract

BACKGROUND

The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.

OBJECTIVES

(1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.

METHODS

We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors' knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.

RESULTS

The key moments where participants felt they needed the most support were "treatment", "report of findings", "informed consent", "physical examination", and "before the appointment". All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.

CONCLUSION

Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.

摘要

背景

加拿大脊骨神经医学协会（CCA）启动了一项质量改进项目，旨在制定最佳实践，以改善患者体验。

目的

（1）确定并优先考虑新患者体验中可以通过为脊骨神经科医生提供重点支持和资源来改善的关键环节；（2）探讨实施这些最佳实践的观点、障碍和促进因素；（3）制定建议，以促进这些实践的采用。

方法

我们采用以人为中心的设计方法进行了定性需求评估，重点是了解最终用户的需求和体验，以创建定制的解决方案。理论领域框架（TDF）用于探索脊骨神经科医生的知识使用和行为改变，将 TDF 领域映射到行为改变技术（BCTs），以制定针对已确定障碍和促进因素的有针对性策略。来自加拿大各地的 13 名脊骨神经科医生参与了半结构化访谈和相关活动。

结果

参与者认为他们最需要支持的关键环节是“治疗”、“报告结果”、“知情同意”、“体检”和“预约前”。所有参与者都同意最佳实践的初始陈述。主要障碍包括知识、沟通技巧和资源可用性方面的差距，特别是在农村地区。促进因素包括与其他卫生专业人员的合作、指导和获得实践工具。建议包括加强沟通和治疗计划方面的培训、增加农村地区的资源获取、以及促进卫生专业人员之间的合作关系。