Missed opportunities for earlier treatment? A qualitative interview study with parents of children admitted to hospital with serious respiratory tract infections
Missed opportunities for earlier treatment? A qualitative interview study with parents of children admitted to hospital with serious respiratory tract infections
复制标题
DOI：
10.1136/adc.2010.188680
复制
发表时间：
2011-02-01
影响因子：
5.2
通讯作者：
Butler, Christopher C.
中科院分区：
文献类型：
--
作者：
Francis, Nick A.;Crocker, Joanna C.;Butler, Christopher C.
目的探讨并发呼吸道感染（RTI）患儿早期干预的可能时机。设计定性、面对面、个体访谈研究，在医院或家中对因复杂RTI入院儿童的父母进行研究。参与者从英国一家大型教学医院招募，并描述入院前的事件（大部分）。研究对象：22名儿童家长（12名脓胸，8名肺炎，1名腹膜周围脓肿，1名乳突炎）。结果由于父母和卫生服务的相关因素，家长的报告显示错过了及时治疗的机会。与父母因素有关的主题包括评估疾病严重程度的问题（5名父母），对获得卫生服务的信念（10名父母；包括害怕出现“神经质”，相信他们的担忧不会被认真对待，相信他们的孩子不会被开抗生素或开抗生素太容易），以及感到无力挑战临床权威（7名父母）。与保健服务相关的因素包括感知到的获得保健服务的问题（13名父母；包括初级保健分类不足、获得及时咨询的障碍和过去获得保健服务的问题导致未能咨询的经验）和感知到的临床就诊质量差（11名父母；包括评估和沟通不足）。酌情处理这些与父母（技能、恐惧和信念）和卫生服务（获取和咨询质量）相关的因素，可能会使重病儿童得到更及时的护理。
Objective To identify potential opportunities for earlier intervention among children who develop a complicated respiratory tract infection (RTI).Design Qualitative, face-to-face, individual interview study, either in hospital or at home, with parents of children admitted to hospital with a complicated RTI.Setting Participants were recruited from a large UK teaching hospital, and described events (largely) prior to hospital admission.Participants Parents of 22 children (12 with empyema, 8 with pneumonia, 1 with peritonsillar abscess and 1 with mastoiditis).Results Parents' accounts revealed missed opportunities for timely treatment resulting from parental and health service associated factors. Themes relating to parental factors included problems assessing the severity of the illness (5 parents), beliefs about accessing health services (10 parents; including fear of appearing 'neurotic', belief that their concerns would not be taken seriously, and belief that their child would not be prescribed antibiotics or would be prescribed antibiotics too readily) and feeling powerless to challenge clinical authority (7 parents). Health service associated factors included perceived problems accessing healthcare services (13 parents; including inadequate primary care triage, barriers to accessing timely consultations and past experience of problems accessing healthcare leading to failure to consult) and perceived poor quality clinical encounters (11 parents; including inadequate assessment and communication).Conclusion Addressing, where appropriate, these parental (skills, fears and beliefs) and health service (access and consultation quality) associated factors may lead to more prompt care for seriously ill children.