Chan Brian, Hulen Elizabeth, Edwards Samuel T, Geduldig Anna, Devoe Meg, Nicolaidis Christina, Korthuis P Todd, Saha Somnath
From the Division of General Internal Medicine and Geriatrics, Addiction Medicine Section, Oregon Health & Science University, Portland, OR (BC, STE, MD, CN, PTK); Central City Concern, Portland OR (BC, AG, MD); Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland OR (EH, STE, SS); School of Medicine, Oregon Health & Science University, Portland OR (AG, CN); School of Social Work, Portland State University, Portland OR (CN); School of Public Health, Oregon Health & Science University and Portland State University, Portland OR (PTK); Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD (SS).
J Am Board Fam Med. 2025 Feb 20;37(5):888-899. doi: 10.3122/jabfm.2023.230403R1.
There is great interest in intensive primary care interventions to address high utilization among medically and socially complex patients. How patients experience these interventions has received less attention.
To better understand patients' experience of intensive primary care, we interviewed patients receiving care from the Streamlined Unified Meaningfully Managed Interdisciplinary Team (SUMMIT), an ambulatory intensive care intervention at an urban federally qualified health center.
We interviewed 25 participants enrolled in the SUMMIT randomized controlled trial and conducted a Reflective Thematic Analysis using a hybrid inductive-deductive approach.
Patients reported high levels of medical and social needs that outstripped prior levels of care and resources. They perceived multiple benefits of SUMMIT through the following themes: 1) Team-based care with improved access to services. Patients appreciated their medical and social needs being met, through higher-level, multidisciplinary care. 2) Caring relationships. Patients described the SUMMIT team as being like family and felt that team members had a genuine sense of duty and obligation toward them. 3) Overcoming stigma. Patients felt valued and treated with dignity. 4) Evolving self-efficacy. Over time, patients experienced increasing success, including engagement in care and improved health behaviors.
Patients perceived the SUMMIT team as better meeting their health-related needs, compared with traditional primary care. They spoke of the team as family and felt humanized and supported in overcoming barriers to engagement, which led to increased self-efficacy. Evaluations assessing the effectiveness of intensive primary care should measure potential patient-centered benefits beyond short-term utilization and cost reduction.
对于强化初级保健干预措施以解决医疗和社会复杂患者的高利用率问题，人们有着浓厚的兴趣。然而，患者如何体验这些干预措施却较少受到关注。
为了更好地了解患者对强化初级保健的体验，我们采访了在一个城市联邦合格健康中心接受简化统一有意义管理跨学科团队（SUMMIT）门诊强化护理干预的患者。
我们采访了参与SUMMIT随机对照试验的25名参与者，并采用归纳 - 演绎混合方法进行了反思性主题分析。
患者报告了高水平的医疗和社会需求，这些需求超过了先前的护理水平和资源。他们通过以下主题感受到了SUMMIT的多重益处：1）基于团队的护理，改善了服务可及性。患者赞赏通过更高水平的多学科护理，他们的医疗和社会需求得到了满足。2）关怀关系。患者将SUMMIT团队形容为像家人一样，并且觉得团队成员对他们有着真诚的责任感和义务感。3）克服耻辱感。患者感到被重视且受到有尊严的对待。4）自我效能感的提升。随着时间的推移，患者取得了越来越多的成功，包括参与护理和改善健康行为。
与传统初级保健相比，患者认为SUMMIT团队能更好地满足他们与健康相关的需求。他们将团队视为家人，并感到在克服参与障碍方面得到了人性化的支持，这导致了自我效能感的增强。评估强化初级保健有效性的评价应衡量除短期利用率和成本降低之外潜在的以患者为中心的益处。
