The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland
The rhetoric and reality of integrated patient-centered care for healthcare providers: An ethnographic exploration of epilepsy care in Ireland
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DOI：
10.1016/j.yebeh.2019.02.011
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发表时间：
2019-05-01
影响因子：
2.6
通讯作者：
Fitzsimons, Mary
中科院分区：
文献类型：
--
作者：
Byrne, John-Paul;Power, Robert;Fitzsimons, Mary
根据世界各地的医疗保健改革，爱尔兰的国家癫痫临床计划（NCPE）描述了一种旨在实现以人（患者）为中心的整体综合护理（PCC）的模式。虽然利益攸关方普遍欢迎，但实现全国促进平等委员会的宏伟目标所需的步骤以及参与者是否准备好踏上这段旅程尚不清楚。本研究探讨了爱尔兰癫痫护理生态系统中的医疗保健提供者的看法，以了解他们的准备程度，以实现综合PCC模式的好处。民族志实地调查，包括观察不同的临床设置在爱尔兰的三个地区和一对一的访谈顾问癫痫学家（n = 3），癫痫专科护士（n = 5），全科医生（n = 4），和高级医疗管理人员（n = 3）进行。虽然有一个以人为本的氛围和倾向于推进综合PCC，有限制的准备癫痫护理环境，以充分满足医疗保健改革的愿望。具体如下：不发达的医疗合作伙伴关系：，护理协调不良：，创新的意外后果：，以及速度和生产力之间的紧张关系。在从政策到实践的过程中，以下多重紧张关系相互碰撞：政策旨在改善所有患者的服务，同时个性化护理：对生产力的需求限制了参与增量和迭代改进举措所需的时间和空间。理解这些紧张关系是实现PCC综合实施的重要第一步。(C)2019爱思唯尔公司All rights reserved.
In line with healthcare reform across the world, the National Clinical Programme for Epilepsy (NCPE) in Ireland describes a model that aims to achieve holistic integrated person (patient)-centered care (PCC). While generally welcomed by stakeholders, the steps required to realize the NCPE ambition and the preparedness of those involved to make the journey are not clear. This study explored the perceptions of healthcare providers in the Irish epilepsy care ecosystem to understand their level of readiness to realize the benefits of an integrated PCC model. Ethnographic fieldwork including observations of different clinical settings across three regions in Ireland and one-to-one interviews with consultant epileptologists (n = 3), epilepsy specialist nurses (n = 5), general practitioners (n = 4), and senior healthcare managers (n = 3) were conducted. While there is a person-centered ambiance and a disposition toward advancing integrated PCC, there are limits to the readiness of the epilepsy care environment to fully meet the aspirations of healthcare reform. These are the following: underdeveloped healthcare partnerships:, poor care coordination:, unintended consequences of innovation:, and tension between pace and productivity. In the journey from policy to practice, the following multiple tensions collide: policy aims to improve services for all patients while simultaneously individualizing care: demands for productivity limit the time and space required to engage in incremental and iterative improvement initiatives. Understanding these tensions is an essential first step on the pathway to integrated PCC implementation. (C) 2019 Elsevier Inc. All rights reserved.