Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers.
Managing multiple chronic conditions in the community: a Canadian qualitative study of the experiences of older adults, family caregivers and healthcare providers.
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在社区中管理多种慢性病：加拿大对老年人，家庭护理人员和医疗保健提供者的经历的定性研究。
DOI：
10.1186/s12877-017-0431-6
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发表时间：
2017-01-31
期刊：
影响因子：
4.1
通讯作者：
Emili A
中科院分区：
文献类型：
--
作者：
Ploeg J;Matthew-Maich N;Fraser K;Dufour S;McAiney C;Kaasalainen S;Markle-Reid M;Upshur R;Cleghorn L;Emili A
在全世界范围内，老年人中多种慢性病的患病率正在增加，这与健康状况不佳以及医疗保健利用率和费用高有关。目前的保健和社会服务没有满足这一群体或其家庭照顾者的复杂需要。需要从多个角度更好地了解MCC的经验，以改进照顾这一弱势群体的方法。然而，MCC的经验尚未与社区生活的老年人，家庭照顾者和医疗保健提供者的广泛样本进行探讨。本研究的目的是探讨管理MCC的经验，在社区的角度来看，老年人与MCC，家庭照顾者和医疗服务提供者在各种设置工作。使用索恩的解释性描述方法，半结构化访谈（n = 130）进行了两个加拿大省份的41个社区生活的老年人（年龄65岁及以上）与三个或更多的慢性疾病，47个家庭照顾者（年龄18岁及以上），和42个医疗保健提供者在各种社区环境中工作。医疗保健提供者代表了各种学科和环境。访谈记录进行了分析，使用索恩的解释性描述方法。与会者将管理千年挑战的经历描述为：（a）不堪重负、疲惫不堪和复杂;（B）安排药片和预约;（c）被分成几部分;（d）照医生说的做;（e）依靠家人和朋友;（f）难以获得外界帮助。这些主题与MCC对所有三组参与者的情感影响以及严重依赖家庭护理人员来支持家庭护理产生了共鸣。在社区管理千年挑战委员会的经验非常复杂，老年人和照顾者的需求与卫生和社会护理系统满足这些需求的能力之间存在很大差距。MCC的医疗保健是零碎和分散的，很少关注个人和家庭作为一个整体。这些研究结果提供了一个基础，护理流程的设计，以更好地解决需求服务的差距，是不可分割的管理MCC的经验。
The prevalence of multiple chronic conditions (MCC) among older persons is increasing worldwide and is associated with poor health status and high rates of healthcare utilization and costs. Current health and social services are not addressing the complex needs of this group or their family caregivers. A better understanding of the experience of MCC from multiple perspectives is needed to improve the approach to care for this vulnerable group. However, the experience of MCC has not been explored with a broad sample of community-living older adults, family caregivers and healthcare providers. The purpose of this study was to explore the experience of managing MCC in the community from the perspectives of older adults with MCC, family caregivers and healthcare providers working in a variety of settings. Using Thorne’s interpretive description approach, semi-structured interviews (n = 130) were conducted in two Canadian provinces with 41 community-living older adults (aged 65 years and older) with three or more chronic conditions, 47 family caregivers (aged 18 years and older), and 42 healthcare providers working in various community settings. Healthcare providers represented various disciplines and settings. Interview transcripts were analyzed using Thorne’s interpretive description approach. Participants described the experience of managing MCC as: (a) overwhelming, draining and complicated, (b) organizing pills and appointments, (c) being split into pieces, (d) doing what the doctor says, (e) relying on family and friends, and (f) having difficulty getting outside help. These themes resonated with the emotional impact of MCC for all three groups of participants and the heavy reliance on family caregivers to support care in the home. The experience of managing MCC in the community was one of high complexity, where there was a large gap between the needs of older adults and caregivers and the ability of health and social care systems to meet those needs. Healthcare for MCC was experienced as piecemeal and fragmented with little focus on the person and family as a whole. These findings provide a foundation for the design of care processes to more optimally address the needs-service gap that is integral to the experience of managing MCC.