My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity.
My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity.
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DOI：
10.1007/s11606-022-07533-1
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发表时间：
2022-12
影响因子：
5.7
通讯作者：
Sayre, George
中科院分区：
文献类型：
--
作者：
Schuttner, Linnaea;Hockett Sherlock, Stacey;Simons, Carol E.;Johnson, Nicole L.;Wirtz, Elizabeth;Ralston, James D.;Rosland, Ann-Marie;Nelson, Karin;Sayre, George
关键词：
以患者为中心的护理反映了患者的偏好和需求，是高质量护理的组成部分。个体化护理对于患有多种慢性疾病的心理社会复杂或高风险患者（即，多发病），因为干预措施的潜在风险更大，效益减少。这些患者在初级保健中越来越普遍。很少有研究从临床医生的角度研究以患者为中心的护理，特别是从美国退伍军人健康管理局内的综合，以患者为中心的医疗家庭环境中服务的初级保健医生。我们试图澄清退伍军人健康管理局的初级保健医生所认为的促进者和障碍，为高危或复杂的多Morphine患者提供以患者为中心的护理。我们于2020年4月至7月对20个临床中心的医生进行了半结构化电话访谈。基于以患者为中心的概念模型和影响护理提供的分层因素，通过演绎内容分析对调查结果进行了分析。在接受访谈的23名医生中，大多数是女性（n = 14/23，61%），在医院附属门诊部服务（n = 14/23，61%）。参与者平均有21年（SD = 11.3）的经验。促进者包括以下内容：有效的医患沟通，以个性化护理，优先考虑多种需求，并引出目标，以提高患者的参与度;获得护理，由跨学科团队启用，并口述个性化的护理计划;努力但值得的护理协调和连续性;通过有效的团队合作满足复杂的需求;以及整合医疗和非医疗护理方面，以识别患者的心理社会背景。障碍包括：内部和人际（例如，感知到的患者不愿意参与护理）;组织的（例如，有限的相遇时间）;以及社区或政策障碍（例如，以病人为中心的护理。医生认为，个人的医患互动是最大的促进者或障碍，以病人为中心的护理。努力增加初级保健患者为中心的复杂或高风险的患者与多morphism可以集中在针对医患沟通和减少人际冲突。
Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients’ psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
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