Home visits - central to primary care, tradition or an obligation? A qualitative study.
Home visits - central to primary care, tradition or an obligation? A qualitative study.
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DOI：
10.1186/1471-2296-12-24
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发表时间：
2011-04-22
影响因子：
2.9
通讯作者：
Hummers-Pradier E
中科院分区：
文献类型：
--
作者：
Theile G;Kruschinski C;Buck M;Müller CA;Hummers-Pradier E
据称，家访是初级保健的核心要素。然而，尽管慢性病老年患者的数量有所增加，但在国际和德国，家访的频率都在下降。鉴于此，问题是如何确保这一弱势患者群体获得足够的初级卫生保健服务。本研究的目的是探讨德国全科医生 (GP) 对德国初级保健中持续家访的可行性、负担和前景的态度。对来自德国汉诺威市及其农村地区的 24 名全科医生进行了定性半结构化访谈。使用定性内容分析对数据进行分析。全科医生表示，他们经常进行家访，但并非所有人都相信这样做的好处。大多数人并没有真正的动力去家访，但有些人觉得有必要这样做。家访的基本条件被描述为不能令人满意，特别是在报销和时间限制方面。对弱势老年人的上门拜访仍然没有争议，而社交性质的探访大多被删除。紧急上门服务越来越多地委托给紧急服务部门。探访疗养院被描述为情绪上令人痛苦。全科医生认为与护理人员的良好合作是确保成功拜访疗养院的关键因素。全科医生希望减轻工作负担，同时仍确保高质量的家庭护理，但无法建议如何实现这一目标。最常提出的是更好的经济补偿。经过专门培训的护士的参与被认为是可能的，但人们对此持不满态度。在德国，家访仍然是初级保健的一个组成部分，并且给许多诊所带来了相当大的工作量。尽管人们普遍认为现有的情况并不令人满意，但如果要求德国全科医生考虑当前的安排在未来是否可持续，他们无法设想替代方案。为了保证初级家庭护理的质量不变，德国全科医生和医疗保健政策制定者应积极发起关于未来家访的必要性和性质的辩论。
Home visits are claimed to be a central element of primary care. However, the frequency with which home visits are made is declining both internationally and in Germany despite the increase in the number of chronically ill elderly patients. Given this, the question arises as to how to ensure sufficient primary health care for this vulnerable patient group. The aim of this study was to explore German general practitioners' (GPs) attitudes with regard to the feasibility, burden and outlook of continued home visits in German primary care. Qualitative semi-structured interviews were carried out with 24 GPs from the city of Hannover, Germany, and its rural surroundings. Data was analysed using qualitative content analysis. The GPs indicated that they frequently conduct home visits, but not all of them were convinced of their benefit. Most were not really motivated to undertake home visits but some felt obliged to. The basic conditions covering home visits were described as unsatisfactory, in particular with respect to reimbursement and time constraints. House calls for vulnerable, elderly people remained undisputed, whereas visits of a social nature were mostly deleted. Urgent house calls were increasingly delegated to the emergency services. Visits to nursing homes were portrayed as being emotionally distressing. GPs considered good cooperation with nursing staff the key factor to ensure a successful nursing home visit. The GPs wanted to ease their work load while still ensuring quality home care but were unable to suggest how this might be achieved. Better financial compensation was proposed most often. The involvement of specially trained nurses was considered possible, but viewed with resentment. Home visits are still an integral aspect of primary care in Germany and impose a considerable workload on many practices. Though the existing situation was generally perceived as unsatisfactory, German GPs could not envisage alternatives if asked to consider whether the current arrangements were sustainable in the future. To guarantee an unaltered quality of primary home care, German GPs and health care policy makers should actively initiate a debate on the need for and nature of home visits in the future.
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影响因子：
--
作者：
Aylin, P;Majeed, FA;Cook, DG
通讯作者：
Cook, DG
影响因子：
3.3
作者：
Kao, Helen;Conant, Rebecca;McCormick, Wayne
通讯作者：
McCormick, Wayne
影响因子：
5.9
作者：
Edwards, Martin;Bobb, Carol;Robinson, Susan I.
通讯作者：
Robinson, Susan I.
DOI：
10.1093/gerona/56.10.m603
发表时间：
2001-10-01
影响因子：
5.1
作者：
Leff, B;Burton, JR
通讯作者：
Burton, JR
影响因子：
2.2
作者：
Svab, I;Kravos, A;Vidmar, G
通讯作者：
Vidmar, G