Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns.
Primary care physicians, acupuncture and chiropractic clinicians, and chronic pain patients: a qualitative analysis of communication and care coordination patterns.
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DOI：
10.1186/s12906-016-1005-4
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发表时间：
2016-01-25
影响因子：
--
通讯作者：
DeBar LL
中科院分区：
文献类型：
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作者：
Penney LS;Ritenbaugh C;Elder C;Schneider J;Deyo RA;DeBar LL
慢性肌肉骨骼疼痛 (CMP) 治疗系统由不同的人、不同的观点组成。虽然传统卫生系统内的护理沟通和协调经常存在问题，但当提供者使用不同的解释模型并且不在同一卫生管理系统内时，似乎有更多机会出现沟通中断。我们试图从对抗疗法提供者、针灸和脊椎按摩师 (A/C) 提供者以及 CMP 患者的角度描述围绕慢性疼痛管理的沟通系统。我们在对 CMP 患者经历进行纵向研究的背景下，收集了管理护理系统中的 CMP 患者 (n = 90) 和初级保健医生 (PCP) (n = 25) 以及从系统中获得高水平转诊的社区针灸和脊椎按摩治疗提供者 (n = 14) 的定性数据。该系统的主要利益相关者之间存在多个分歧点和沟通障碍。最常提到的问题包括围绕转诊流程（请求、批准）的问题以及缺乏返回到提供者的一致信息，从而损害了患者护理的整体管理。我们发现，由于这些问题，CMP 患者经常需要整合和协调自己的护理，有时甚至不知所措，而系统的帮助却很少。患者、PCP 和 A/C 提供者希望加强沟通；因此，需要创建系统来促进更开放的沟通，从而对患者的治疗结果产生积极的影响。
A variety of people, with multiple perspectives, make up the system comprising chronic musculoskeletal pain (CMP) treatment. While there are frequently problems in communication and coordination of care within conventional health systems, more opportunities for communicative disruptions seem possible when providers use different explanatory models and are not within the same health management system. We sought to describe the communication system surrounding the management of chronic pain from the perspectives of allopathic providers, acupuncture and chiropractor (A/C) providers, and CMP patients. We collected qualitative data from CMP patients (n = 90) and primary care physicians (PCPs) (n = 25) in a managed care system, and community acupuncture and chiropractic care providers (n = 14) who received high levels of referrals from the system, in the context of a longitudinal study of CMP patients’ experience. Multiple points of divergence and communicative barriers were identified among the main stakeholders in the system. Those that were most frequently mentioned included issues surrounding the referral process (requesting, approving) and lack of consistent information flow back to providers that impairs overall management of patient care. We found that because of these problems, CMP patients were frequently tasked and sometimes overwhelmed with integrating and coordinating their own care, with little help from the system. Patients, PCPs, and A/C providers desire more communication; thus systems need to be created to facilitate more open communication which could positively benefit patient outcomes.