Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.
Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions.
复制标题
初级保健临床医生对有多种疾病的老年人进行治疗决策的经验。
DOI：
10.1001/archinternmed.2010.318
复制
发表时间：
2011-01-10
影响因子：
--
通讯作者：
Iannone, Lynne
中科院分区：
文献类型：
--
作者：
Fried, Terri R.;Tinetti, Mary E.;Iannone, Lynne
临床医生正在照顾越来越多的患有多种疾病的老年患者，面对与指南指导的干预措施相关的益处和危害的不确定性。了解初级保健临床医生如何处理这些患者的治疗决策是至关重要的设计，改善决策过程。焦点小组进行了研究，与40名初级保健临床医生（医生，护士执业者，医生助理）在学术，社区和VA附属初级保健实践。向参与者提出了一些开放式问题，询问他们如何为患有多种疾病的老年人作出治疗决策。采用定性内容分析将答复按主题组织。参与者担心他们的患者是否有能力坚持指南指导的复杂治疗方案。关于平衡指南导向护理的益处和危害的信念和方法存在差异。他们如何让患者参与决策过程也存在差异，临床医生描述了他们自己和患者目标之间的冲突。参与者列出了做出良好治疗决定的一些障碍，包括缺乏结果数据，专家的作用，患者和家庭的期望，以及时间和报销不足。执业临床医生的经验表明，他们努力与不确定性的疾病特异性指南应用于他们的老年患者多种条件。为了改善决策，他们需要更多的数据，替代指南，协调自己和患者优先事项的方法，他们的亚专科同事的支持，以及改变的报销制度。
Clinicians are caring for an increasing number of older patients with multiple diseases, in the face of uncertainty concerning the benefits and harms associated with guideline-directed interventions. Understanding how primary care clinicians approach treatment decision-making for these patients is critical to the design of improving the decision-making process. Focus groups were conducted with study with forty primary care clinicians (physicians, nurse-practitioners, physician assistants) in academic, community, and VA-affiliated primary care practices. Participants were given open-ended questions about their approach to treatment decision-making for older persons with multiple medical conditions. Responses were organized into themes using qualitative content analysis. Participants were concerned about their patients’ ability to adhere to complex regimens deriving from guideline-directed care. There was variability in beliefs regarding and approaches to balancing the benefits and harms of guideline-directed care. There was also variability in how they involved patients in the process of decision making, with clinicians describing conflicts between their own and their patients’ goals. Participants listed a number of barriers to making good treatment decisions, including lack of outcome data, the role of specialists, patient and family expectations, and insufficient time and reimbursement. The experiences of practicing clinicians suggest that they struggle with the uncertainties of applying disease-specific guidelines to their older patients with multiple conditions. To improve decision making, they need more data, alternative guidelines, approaches to reconciling their own and their patients’ priorities, the support of their subspecialist colleagues, and an altered reimbursement system.
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影响因子：
120.7
作者：
Boyd, CM;Darer, J;Wu, AW
通讯作者：
Wu, AW
影响因子：
--
作者：
Sloane, PD;Gruber-Baldini, AL;Hebel, JR
通讯作者：
Hebel, JR
DOI：
10.1111/j.1532-5415.2004.52467.x
发表时间：
2004-10-01
影响因子：
6.3
作者：
Agostini, JV;Han, L;Tinetti, ME
通讯作者：
Tinetti, ME
影响因子：
39.2
作者：
Huang, Elbert S.;Zhang, Qi;Meltzer, David O.
通讯作者：
Meltzer, David O.
影响因子：
3.6
作者：
Llewellyn-Thomas, HA;Paterson, JM;Naylor, CD
通讯作者：
Naylor, CD