Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness
Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness
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DOI：
10.1186/1472-6963-14-281
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发表时间：
2014-06-26
影响因子：
2.8
通讯作者：
Shippee, Nathan
中科院分区：
文献类型：
--
作者：
May, Carl R.;Eton, David T.;Shippee, Nathan
背景：在这篇文章中，我们概述了治疗负担理论，这是一个关于病人、他们的社会网络和医疗服务之间关系的新模型。卫生服务机构面临着人口增长的挑战，这些人患有长期和限制生命的疾病，他们对此作出了回应，将旨在控制症状和延缓--有时甚至预防--疾病进展的例行工作委托给病人及其网络。这是新的积极主动的工作，患者对此越来越负责任：基于自我护理、自我赋权和自我实现的想法，以及可以从诊所转移到社区的新技术和治疗模式。这些对患者提出了新的要求，他们可能会经历治疗的负担。讨论：随着负担的累积，一些患者不堪重负，其后果可能是个别患者的医疗结果不佳，照顾者的压力增加，医疗服务的需求和成本上升。面对这些挑战，我们需要更好地了解患者在对疾病负担和治疗负担的需求做出反应时所利用的资源，以及资源与医疗利用的互动方式。总结：治疗负担理论旨在了解行动能力如何与源于医疗保健的工作相互作用。治疗负担理论是一个结构模型，它侧重于患者及其网络所做的工作。因此，它帮助我们了解在不同的医疗保健环境和临床环境下，医疗保健利用率和依从性的差异。
Background: In this article we outline Burden of Treatment Theory, a new model of the relationship between sick people, their social networks, and healthcare services. Health services face the challenge of growing populations with long-term and life-limiting conditions, they have responded to this by delegating to sick people and their networks routine work aimed at managing symptoms, and at retarding - and sometimes preventing -disease progression. This is the new proactive work of patient-hood for which patients are increasingly accountable: founded on ideas about self-care, self-empowerment, and self-actualization, and on new technologies and treatment modalities which can be shifted from the clinic into the community. These place new demands on sick people, which they may experience as burdens of treatment.Discussion: As the burdens accumulate some patients are overwhelmed, and the consequences are likely to be poor healthcare outcomes for individual patients, increasing strain on caregivers, and rising demand and costs of healthcare services. In the face of these challenges we need to better understand the resources that patients draw upon as they respond to the demands of both burdens of illness and burdens of treatment, and the ways that resources interact with healthcare utilization.Summary: Burden of Treatment Theory is oriented to understanding how capacity for action interacts with the work that stems from healthcare. Burden of Treatment Theory is a structural model that focuses on the work that patients and their networks do. It thus helps us understand variations in healthcare utilization and adherence in different healthcare settings and clinical contexts.