Fried T R, van Doorn C, Tinetti M E, Drickamer M A
Veterans Affairs Connecticut Healthcare System, Yale University School of Medicine, West Haven, USA.
J Gen Intern Med. 1998 Aug;13(8):522-7. doi: 10.1046/j.1525-1497.1998.00162.x.
To explore how older persons form preferences for site of medical care by examining their perceptions of home care and hospital care.
Qualitative analysis of in-depth interviews using the constant comparative method.
Respondents' homes.
Twenty-nine persons age 65 to 89 years who had been hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia and were receiving home care services.
Respondents, who thought of home care only as a means to provide low-intensity and low-frequency services, were initially skeptical about expanded home care services to treat acute illness. Regardless of their opinions about home and hospital, all respondents preferred the site associated with the greatest chance of survival. If the sites offered equal survival, 52% of the respondents preferred treatment at home because of freedom from the constraints of the hospital and the comfort of familiar surroundings. For respondents who preferred the hospital, the home represented a frightening and lonely place to be sick. Respondents' views of the home and hospital were shaped by their social supports, self-reliance, religious beliefs, and past illness experiences.
Because survival appears to be the most important determinant of preference, home treatment of acute illness is a viable alternative only if it provides outcomes equivalent to those of hospitalization. Strongly held perceptions that home care can only be a low-intensity service may limit preferences for home treatment. When expected outcomes at the two sites are similar, the challenge to the health care system will be incorporating patient preference about the process of care into decisions about the appropriate site of care.
通过研究老年人对家庭护理和医院护理的认知，探讨他们如何形成对医疗护理地点的偏好。
采用持续比较法对深入访谈进行定性分析。
受访者家中。
29名年龄在65至89岁之间的老年人，他们曾因充血性心力衰竭、慢性阻塞性肺疾病或肺炎住院，目前正在接受家庭护理服务。
受访者最初认为家庭护理只是提供低强度、低频服务的一种方式，因此对扩大家庭护理服务以治疗急性疾病持怀疑态度。无论他们对家庭和医院的看法如何，所有受访者都更倾向于选择生存几率最大的护理地点。如果两个地点的生存几率相同，52%的受访者更愿意在家接受治疗，因为这样可以摆脱医院的限制，享受熟悉环境带来的舒适。对于那些更倾向于医院的受访者来说，家是一个生病时既可怕又孤独的地方。受访者对家庭和医院的看法受到他们的社会支持、自立能力、宗教信仰以及过去患病经历的影响。
由于生存似乎是偏好的最重要决定因素，只有当家庭治疗能提供与住院治疗相当的效果时，急性疾病的家庭治疗才是一种可行的选择。人们强烈认为家庭护理只能是低强度服务，这可能会限制对家庭治疗的偏好。当两个地点的预期结果相似时，医疗保健系统面临的挑战将是把患者对护理过程的偏好纳入到关于合适护理地点的决策中。
