Defining good health and care from the perspective of persons with multimorbidity: results from a qualitative study of focus groups in eight European countries
Defining good health and care from the perspective of persons with multimorbidity: results from a qualitative study of focus groups in eight European countries
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DOI：
10.1136/bmjopen-2017-021072
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发表时间：
2018-08-01
期刊：
影响因子：
2.9
通讯作者：
Rutten-van Molken, Maureen P. M. H.
中科院分区：
文献类型：
--
作者：
Leijten, Fenna R. M.;Hoedemakers, Maaike;Rutten-van Molken, Maureen P. M. H.
目标 在许多西方国家，多种疾病的患病率正在增加。患有多种疾病的人经常会遇到多个健康和社会护理组织提供的护理缺乏一致性的情况。作为回应，综合护理计划正在出现。评估这些并选择适当的结果衡量标准是一项挑战。在八个欧洲国家与患有多种疾病的人一起举办了焦点小组，以更好地了解良好的健康和良好的护理过程对他们意味着什么，并确定他们认为最重要的是什么。 方法 2016 年，在奥地利、克罗地亚、德国、匈牙利、荷兰、挪威、西班牙和英国（总共 n=58）为患有多种疾病的人组织了八个焦点小组。每个焦点小组都遵循相同的两部分程序：（1）定义（A）良好的健康和福祉以及（B）良好的护理过程，以及（2）小组讨论，优先考虑第一部分和从文献中提取的列表中得出的最重要的概念。进行了归纳和演绎分析。结果总体而言，所有焦点小组的参与者更多地关注护理过程而不是健康。患有多种疾病的人将良好的健康定义为能够进行和计划正常的日常活动，拥有有意义的社会关系并接受当前状况。没有羞耻、恐惧和/或耻辱、能够享受生活和整体心理健康也是健康的重要方面。据说，护理专业人员的全面帮助对于良好的护理过程至关重要。持续的护理和信任专业人员也被认为很重要。各国之间的健康定义几乎没有差异，但在定义良好的护理过程方面存在差异。 结论 在评估针对多病患者的综合护理计划时，应包括涉及福祉、社会和心理方面的各种健康结果，尤其是护理结果的经验。
Objectives The prevalence of multimorbidity is increasing in many Western countries. Persons with multimorbidity often experience a lack of alignment in the care that multiple health and social care organisations provide. As a response, integrated care programmes are appearing. It is a challenge to evaluate these and to choose appropriate outcome measures. Focus groups were held with persons with multimorbidity in eight European countries to better understand what good health and a good care process mean to them and to identify what they find most important in each.Methods In 2016, eight focus groups were organised with persons with multimorbidity in: Austria, Croatia, Germany, Hungary, the Netherlands, Norway, Spain and the UK (total n=58). Each focus group followed the same two-part procedure: (1) defining (A) good health and well-being and (B) a good care process, and (2) group discussion on prioritising the most important concepts derived from part one and from a list extracted from the literature. Inductive and deductive analyses were done.Results Overall, the participants in all focus groups concentrated more on the care process than on health. Persons with multimorbidity defined good health as being able to conduct and plan normal daily activities, having meaningful social relationships and accepting the current situation. Absence of shame, fear and/or stigma, being able to enjoy life and overall psychological well-being were also important facets of good health. Being approached holistically by care professionals was said to be vital to a good care process. Continuity of care and trusting professionals were also described as important. Across countries, little variation in health definitions were found, but variation in defining a good care process was seen.Conclusion A variety of health outcomes that entail well-being, social and psychological facets and especially experience with care outcomes should be included when evaluating integrated care programmes for persons with multimorbidity.