Rewards and Challenges of Community Health Center Practice
Rewards and Challenges of Community Health Center Practice
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社区卫生服务中心实践的收获与挑战
DOI：
10.1177/2150131913501519
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发表时间：
2014
影响因子：
3.6
通讯作者：
N. Stevens
中科院分区：
文献类型：
--
作者：
A. Cole;Frederick M. Chen;P. Ford;W. Phillips;N. Stevens
背景：美国1100多个社区卫生中心（CHCs）每年为2000万缺医少药的患者提供初级保健。CHCs一直在努力招聘和留住合格的医生。目的：了解中西医结合医院医师的工作经历，确定满意度和不满意度的主要来源。方法：采用有目的的抽样方法，对12名在CHCs执业的家庭医生进行半结构化访谈。访谈问题评估了医生在CHCs的经历以及满意度和不满意度的来源。访谈记录由两名调查人员编码和分析，使用扎根的理论方法来确定关键主题。结果：虽然家庭医生从护理不足的病人中感到极大的满足，但他们对他们所经历的压倒性工作量感到沮丧。家庭医生在CHCs工作时也报告行政管理不善。结论：《平价医疗法案》的实施依赖于CHC服务的扩大，可能会受到家庭医生对CHC实践的挫折的不利影响。可能需要进一步的研究来探索和潜在地改善CHC的工作环境。
Background: More than 1100 community health centers (CHCs) in the United States provide primary care to 20 million underserved patients annually. CHCs have struggled to recruit and retain qualified physicians. Objective: To understand physicians’ work experiences in CHCs and identify major sources of satisfaction and dissatisfaction. Methods: Using purposeful sampling, we conducted semistructured interviews with 12 family physicians practicing in CHCs. Interview questions assessed physicians’ experiences in CHCs and sources of satisfaction and dissatisfaction. Interview notes were coded and analyzed by 2 investigators using a grounded theory approach to identify key themes. Results: Though family physicians feel tremendous satisfaction from care of underserved patients, they are frustrated with the overwhelming workload they experience. Family physicians also report poor administrative management while working in CHCs. Conclusions: Implementation of the Affordable Care Act, which relies on expansion of CHC services, may be adversely affected by family physicians’ frustrations with CHC practice. Further research to explore and potentially improve the CHC work environment may be needed.