A categorisation of problems and solutions to improve patient referrals from primary to specialty care
A categorisation of problems and solutions to improve patient referrals from primary to specialty care
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DOI：
10.1186/s12913-018-3745-y
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发表时间：
2018-12-20
影响因子：
2.8
通讯作者：
Marshall, Deborah A.
中科院分区：
文献类型：
--
作者：
Greenwood-Lee, James;Jewett, Lauren;Marshall, Deborah A.
背景改善专科护理的可及性已被确定为提供卫生服务的关键问题，特别是考虑到慢性病的负担日益增加。识别和解决影响非紧急程序专科护理患者获得专科护理的问题，以及如何通过卫生系统提供干预措施管理这些缺陷，对于改善慢性病患者的护理非常重要。然而，初级专科护理接口是复杂的，可能会受到各种潜在的卫生服务提供缺陷的影响;开发了一系列平等的干预措施来纠正这些缺陷。因此，文献也多种多样，难以浏览。我们提出了一个叙述性的审查，以确定现有的文献，并提供了一个概念图，分类的问题，在初级专科护理接口与链接到相应的干预措施，旨在确保患者过渡整个初级专科护理接口是必要的，适当的，及时和良好的communicated.MethodsWe搜索MEDLINE和EMBASE数据库从2005年1月1日至2014年12月31日，灰色文献和参考文献列表，以识别报告为改善初级-专科护理界面而实施的干预措施的文章。选定的文章进行了分类，以描述：1）干预的背景下，包括缺陷处理，和干预的目标2）干预活动，和3）干预outcomes.ResultsWe确定了106篇文章，生产四类卫生服务提供缺陷的基础上：1）临床决策; 2）信息管理; 3）系统层面管理初级和二级护理之间的病人流动;以及4）护理质量监测。根据所处理的缺陷和所使用的干预策略，将干预措施分为7类和14个亚类。讨论了干预措施之间潜在的协同作用和权衡。很少有证据存在替代干预strategy.ConclusionThe分类的协同和拮抗的相互作用作为一种援助，确定为什么初级专科护理接口可能会失败，哪些干预措施可能会产生改善。干预措施之间的重叠和相互关联造成了共同实施的干预措施之间的潜在协同作用和冲突。
BackgroundImproving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated.MethodsWe searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes.ResultsWe identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies.ConclusionThe categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.