Patient Preferences Appropriateness/Gery W. Ryan

.项目描述 适当的护理是指确保个人获得（a）临床有效的护理，（B）符合成本效益的护理，并符合（c）道德原则和（d）与个人、社区和社会有关的偏好。考虑到补充和替代医学（CAM）中患者自我转诊的普遍性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进行的，而不是针对特定的疾病发作。本研究以脊椎推拿和活动疗法（M/M）治疗慢性颈椎疼痛为例，探讨患者的偏好、期望和经验在评估治疗和程序的适当性方面可能发挥的作用。 这项研究将分三个阶段进行。在第一阶段，我们将招募患有慢性颈部疼痛的脊椎指压治疗患者，并进行深入的半结构化访谈，了解他们过去和现在治疗颈部疼痛的经验。我们将使用这些访谈，以及文献的全面审查，制定一系列的访谈协议，以评估患者的决策，期望，经验和满意度与他们的脊椎按摩治疗。接下来，我们将对50名目前正在接受脊医治疗的慢性颈椎疼痛患者进行试点测试，并根据需要进行适当的修改。最后确定的方案将成为收集来自四个国家地点的80个脊椎治疗实践的800名慢性颈椎疼痛患者的全国样本数据的基础。 这些数据将为患者的偏好、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提供前所未有的见解。我们还将描述这些如何在社会人口特征，时间，初始疼痛严重程度和以前的经验与脊椎按摩，其他CAM和其他非CAM治疗。由此产生的以患者为中心的结果将被纳入关于使用M/M治疗慢性颈部疼痛的适当性的讨论中。

. 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.