Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status
Contingent engagement: What we learn from patients with complex health problems and low socioeconomic status
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DOI：
10.1016/j.pec.2017.08.019
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发表时间：
2018-03-01
影响因子：
3.5
通讯作者：
Arora, Sanjeev
中科院分区：
文献类型：
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作者：
Komaromy, Miriam;Madden, Erin Fanning;Arora, Sanjeev
目的：方法：对20名有复杂健康问题、经常住院/急诊的成年医疗补助患者进行深入访谈，这些患者参加了旨在解决医疗、行为和社会需求的强化、基于团队的护理计划。在参与该计划之前，参与者描述了与初级保健提供者的关系薄弱，频繁住院和急诊，药物依从性差以及严重的社会障碍。在参与该计划后，参与者确定了使他们能够建立信任并参与护理的关键因素，包括：延长密集互动的可用性，非判断性方法，解决患者的物质需求，以及为孤立患者提供社会联系。在与他们的护理团队建立关系后，参与者描述了变化，例如与他们的初级护理团队的持续互动和健康行为的逐步改善。这些发现阐明了促进具有复杂健康问题的低社会经济地位患者的“应急参与”的因素，这使他们能够以与其情况相称的方式变得积极主动，并为设计干预措施以改善患者结局提供了见解。(c)2017爱思唯尔B. V.保留所有权利。
Objective: Elicit patients' perceptions of factors that facilitate their engagement in careMethods: In-depth interviews with 20 adult Medicaid patients who had complex health problems, frequent hospitalizations/emergency department use, and who were enrolled in an intensive, team-based care program designed to address medical, behavioral, and social needs.Results: Prior to engaging in the program, participants described weak relationships with primary care providers, frequent hospitalizations and emergency visits, poor adherence to medications and severe social barriers to care. After participating in the program, participants identified key factors that enabled them to develop trust and engage with care including: availability for extended intensive interactions, a non-judgmental approach, addressing patients' material needs, and providing social contact for isolated patients. After developing relationships with their care team, participants described changes such as sustained interactions with their primary care team and incremental improvements in health behaviors.Conclusion: These findings illuminate factors promoting "contingent engagement" for low socioeconomic status patients with complex health problems, which allow them to become proactive in ways commensurate with their circumstances, and offers insights for designing interventions to improve patient outcomes. (c) 2017 Elsevier B.V. All rights reserved.