Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators
Shared decision-making and interprofessional collaboration in mental healthcare: a qualitative study exploring perceptions of barriers and facilitators
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DOI：
10.3109/13561820.2013.785503
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发表时间：
2013-09-01
影响因子：
2.7
通讯作者：
Chen, Timothy F.
中科院分区：
文献类型：
--
作者：
Chong, Wei Wen;Aslani, Parisa;Chen, Timothy F.
共同决策和跨专业协作是实现以消费者为中心的护理的重要途径。共享决策的概念最近已经扩展到包括跨专业的医疗保健团队。本研究探讨了医疗保健提供者对共同决策和跨专业合作的障碍和促进因素的看法。对31名保健提供者进行了半结构化访谈，其中包括医生（精神科医生、全科医生）、药剂师、护士、职业治疗师、心理学家和社会工作者。医疗保健提供者确定了几个共同决策的障碍和促进因素，这些因素可分为三个主要主题：与心理健康消费者相关的因素、与医疗保健提供者相关的因素和与医疗保健服务提供相关的因素。心理健康专业提供者经常认为，消费者缺乏参与能力是共同决策的主要障碍，而所有专业的医疗保健提供者都认为，向消费者提供有关疾病和治疗的信息是共同决策的重要促进因素。虽然医疗保健提供者认为跨专业协作受到医疗保健提供者、环境和系统因素的影响，但医疗保健提供者对这些因素的重视程度有所不同。为了促进跨专业合作，精神卫生专业提供者强调提高全科医生和社区药剂师的精神卫生专业知识的重要性，而一般保健提供者则认为，提供者和保健机构之间的信息共享是关键。本研究的结果表明，为了在精神卫生保健中实现有效的共享决策和跨专业协作，可能需要在几个层面（即消费者、提供者和环境）进行改变。
Shared decision-making and interprofessional collaboration are important approaches to achieving consumer-centered care. The concept of shared decision-making has been expanded recently to include the interprofessional healthcare team. This study explored healthcare providers' perceptions of barriers and facilitators to both shared decision-making and interprofessional collaboration in mental healthcare. Semi-structured interviews were conducted with 31 healthcare providers, including medical practitioners (psychiatrists, general practitioners), pharmacists, nurses, occupational therapists, psychologists and social workers. Healthcare providers identified several factors as barriers to, and facilitators of shared decision-making that could be categorized into three major themes: factors associated with mental health consumers, factors associated with healthcare providers and factors associated with healthcare service delivery. Consumers' lack of competence to participate was frequently perceived by mental health specialty providers to be a primary barrier to shared decision-making, while information provision on illness and treatment to consumers was cited by healthcare providers from all professions to be an important facilitator of shared decision-making. Whilst healthcare providers perceived interprofessional collaboration to be influenced by healthcare provider, environmental and systemic factors, emphasis of the factors differed among healthcare providers. To facilitate interprofessional collaboration, mental health specialty providers emphasized the importance of improving mental health expertise among general practitioners and community pharmacists, whereas general health providers were of the opinion that information sharing between providers and healthcare settings was the key. The findings of this study suggest that changes may be necessary at several levels (i.e. consumer, provider and environment) to implement effective shared decision-making and interprofessional collaboration in mental healthcare.