Patient Preferences Appropriateness/Gery W. Ryan

。项目说明 护理的适当性是指确保个人得到(A)临床有效、(B)具有成本效益且符合(C)伦理原则和(D)与个人、社区和社会相关的偏好的护理。鉴于补充和替代医学(CAM)中患者自我转诊的盛行，以及整个卫生系统对以患者为中心的护理的关注，在评估CAM程序的适当性时，考虑个人偏好似乎是合理的。不幸的是，我们对CAM用户的偏好和决策知之甚少，因为大多数CAM研究都是在个人层面上进行的，而不是针对特定的疾病发作。本研究将以推拿手法及活动疗法(M/M)治疗慢性颈痛为例，探讨患者的喜好、期望及经验在评估治疗及程序的适当性方面可能扮演的角色。 研究将分三个阶段进行。在第一阶段，我们会招募来自脊骨疗法的慢性颈部疼痛患者，并就他们过去和现在治疗颈部疼痛的经验进行深入的、半结构化的访谈。我们将利用这些访谈，以及对文献的全面回顾，制定一系列访谈方案，以评估患者的决策、期望、经历和对其脊椎护理的满意度。接下来，我们将在50名目前正在看脊椎指压医生的慢性颈痛患者身上进行试点测试，并根据需要进行适当的改变。然后，最终的方案将成为从全国四个地点的80个脊椎按摩诊所的800名慢性颈痛患者的全国样本中收集数据的基础。 这些数据将提供对患者偏好、期望、医疗保健体验和对这些体验的满意度、报告的短期和长期结果以及对这些结果和治疗适当性的满意度的前所未有的洞察。我们还将描述这些因素在社会人口学特征、时间、初始疼痛严重程度以及脊椎按摩、其他CAM和其他非CAM治疗的既往经历中的差异。由此产生的以患者为中心的发现将被纳入关于使用M/M治疗慢性颈痛是否合适的讨论中。

. Project Description Appropriateness of care is about ensuring that individuals receive care that is (a) clinically effective, (b) cost-effective, and is consistent with (c) ethical principles and (d) preferences relevant to individuals, communities and society. Given the prevalence of patient self-referral in complementary and alternative medicine (CAM) and the health system-wide focus on patient-centered care, it seems reasonable to consider individual preferences when assessing the appropriateness of CAM procedures. Unfortunately, we know very little about CAM users' preferences and decision-making since most CAM studies are conducted at the individual level rather than for specific illness episodes. Using chiropractic manipulation and mobilization (M/M) for chronic cervical pain as an example, this study will explore the role that patients' preferences, expectations and experiences may play in assessing the appropriateness of treatments and procedures. The study will occur in three stages. In the first stage, we will recruit patients suffering from chronic neck pain from chiropractic practices and conduct in-depth, semi-structured interviews about their past and current experiences in treating their neck pain. We will use these interviews, as well as a comprehensive review of the literature; to develop a series of interview protocols for assessing patient decision making, expectations, experiences and satisfaction with their chiropractic care. Next we will pilot test the protocols on 50 chronic cervical pain patients who are currently seeing a chiropractor and make appropriate changes as required. The finalized protocols will then be the basis for collecting data from a national sample of 800 patients with chronic cervical pain from 80 chiropractic practices located in four national sites. These data will provide unprecedented insights into patient preferences, expectations, healthcare experiences and satisfaction with those experiences, reported short- and long-term results and satisfaction with those results and treatment appropriateness. We will also describe how these vary across sociodemographic characteristics, time, initial pain severity and previous experiences with chiropractic, other CAM and other non-CAM treatments. The resulting patient-centered findings will be incorporated into the discussion concerning the appropriateness of utilizing M/M for chronic cervical pain.