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Providers' Competencies and Management Practices for Traditional Palliative Cancer Care Service Delivery in Kenya. 肯尼亚传统姑息性癌症治疗服务提供者的能力和管理实践。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-20 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231211780
Solomon K Cheboi, Wanjiru S Ng'ang'a, Philamon Nyamanga, Stanley Kibet

Background: Many people in developing countries are struggling with chronic diseases yet traditional health services remain under-utilized in the quest for universal health care. Thousands patronize these outlets for care yet little is known about provider's competence and how these competencies inform palliative care decisions and practices. The study documented traditional health practitioners (THPs) competencies and practices for traditional palliative cancer care service delivery in Kenya.

Methods: This study utilized mixed-methods design and was undertaken in major towns across Kenya. A total of 201 Traditional health practitioners were purposely sampled, and interviewed. Five in-depth interviews and 6 focus group discussions were conducted. Quantitative data were analyzed using SPSSv22 while thematic and discourse analysis was carried out for qualitative data.

Results: Majority (92.7%) of the THPs provided general traditional health services. Nearly half of the respondents (47.7%, n = 92) stated that they had received their knowledge and abilities through divine gifting, 71 (36.8%) lineage, 61 (31.6%) apprenticeship, and 39 (20.2%) formal study. Palliative care was determined by patient state and followed consultation with caregivers for 165 (85.5%) of respondents. For 160 respondents (83%), management practices involved a mix of patient examination, conventional medical tests, herbal medicine administration, follow-up or referral. Positive feedback consisted of symptom reduction and function recovery.

Conclusion: Core competencies identified include: knowledge acquisition and specialization, assessment, diagnosis and disclosure, decision making, treatment, follow-up, and referral. Traditional palliative care providers share common health-related beliefs, practices and abilities that influence how they approach and make decisions regarding the health management of their patients, despite marked ethnic diversity. The shared pathways offer a chance to develop a cogent traditional palliative care service delivery model and health policy framework to promote its integration within the health workforce. The leading unmet requirements are knowledge of intellectual property rights, disclosure frameworks, and ethical regulation principles.

背景:发展中国家的许多人正在与慢性病作斗争,但在寻求普及卫生保健的过程中,传统卫生服务仍未得到充分利用。成千上万的人光顾这些护理网点,但对提供者的能力知之甚少,以及这些能力如何告知姑息治疗决策和实践。该研究记录了肯尼亚传统卫生从业人员提供传统姑息性癌症护理服务的能力和做法。方法:本研究采用混合方法设计,并在肯尼亚主要城镇进行。共有201名传统卫生从业人员进行了抽样调查和访谈。进行了5次深度访谈和6次焦点小组讨论。定量数据采用SPSSv22进行分析,定性数据采用专题和语篇分析。结果:绝大多数医院(92.7%)提供一般传统卫生服务。近一半的受访者(47.7%,n = 92)表示,他们的知识和能力是通过神的恩赐获得的,71人(36.8%)来自世系,61人(31.6%)来自学徒,39人(20.2%)来自正式学习。有165名(85.5%)受访者根据患者状态确定姑息治疗,并与护理人员进行了协商。160个答复者(83%)的管理做法包括病人检查、常规医学检查、草药管理、随访或转诊。正反馈包括症状减轻和功能恢复。结论:确定的核心能力包括:知识获取和专业化、评估、诊断和披露、决策、治疗、随访和转诊。尽管存在明显的种族差异,但传统的姑息治疗提供者具有共同的与健康有关的信念、做法和能力,这些信念、做法和能力影响着他们如何处理和作出有关患者健康管理的决定。共享路径为制定令人信服的传统姑息治疗服务提供模式和卫生政策框架提供了机会,以促进其融入卫生工作队伍。未满足的主要需求是知识产权、披露框架和道德监管原则。
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引用次数: 0
Socioeconomic Predictors of Crisis and Clinical Pathways Among People Contacting a Mental Health Crisis Line. 接触心理健康危机热线的人的危机和临床途径的社会经济预测因素。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-16 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231212120
Molly McCarthy, Jason C McIntyre, Rajan Nathan, Emma L Ashworth, Pooja Saini

Objective: Crisis lines are the first mental health service contact point for many people, making them a vital community and public health intervention. Given the current and potential utility of crisis lines, better understanding the characteristics, socioeconomic factors and subsequent referral pathways of callers is critical to identifying targeted ways to improve such services.

Study design: The dataset captured calls to the Cheshire & Wirral Partnership NHS Foundation Trust (CWP) crisis line between August 2020 and August 2021. Calls were examined if self-harm, risk to self, or overdose were reported by the caller. Descriptive analyses were conducted to produce a clinical and demographic profile of the callers using the crisis line.

Results: Call handlers were significantly more likely to call 999, hand over to a practitioner and less likely to provide advice and guidance if self-harm, risk to self or overdose was reported. Social issues were found to be significantly associated with all 3 outcomes: self-harm, risk to self and overdose.

Conclusion: The current study provides the first exploratory analysis of the socioeconomic factors and resultant care pathways for those contacting a UK crisis line service. The findings have important implications for community early intervention efforts to reduce self-harm and suicidal behaviours.

目的:危机热线是许多人的第一个精神卫生服务接触点,使其成为重要的社区和公共卫生干预措施。鉴于危机热线目前和潜在的效用,更好地了解呼叫者的特点、社会经济因素和随后的转诊途径对于确定有针对性的改善此类服务的方法至关重要。研究设计:该数据集捕获了2020年8月至2021年8月期间柴郡和威勒尔伙伴关系NHS基金会信托基金(CWP)危机线的电话。调查人员会检查来电者是否报告有自残、自我风险或服药过量。进行描述性分析,以产生使用危机线呼叫者的临床和人口统计资料。结果:呼叫处理人员更有可能拨打999,移交给医生,而不太可能提供建议和指导,如果自残,自我风险或过量报告。社会问题被发现与所有三种结果显著相关:自残、自我风险和过量用药。结论:目前的研究提供了第一个探索性分析的社会经济因素和由此产生的护理途径,为那些联系英国危机热线服务。这一发现对社区早期干预努力减少自残和自杀行为具有重要意义。
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引用次数: 0
Hospital Discharge Planners Need More Information When Referring Patients to Home Health Care: Insights From the Coronavirus Disease 2019 Pandemic. 医院出院计划者在将患者转介到家庭医疗保健时需要更多信息:来自2019年冠状病毒大流行的见解。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-09 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231211093
Jun Li, Thomas Jeffers, Babatope Ogunjesa, Minakshi Raj

Hospital discharge planners play an important role in helping patients choose appropriate home health care. However, during the COVID-19 pandemic, they may not have had enough information to make the best decisions for their patients. A study of 58 discharge planners from Michigan hospitals found that 90% of them wanted information about the quality of home health agencies and whether they were prepared for COVID-19. However, only about 20% had this information readily available. The study also found that discharge planners varied in how they incorporated quality information. Some did not incorporate any quality information at all, while others provided it to patients without explaining its significance. Only about 25% of discharge planners helped patients interpret different sources of information. These findings suggest that hospital discharge planners had an unmet need for quality information, and they also provided limited assistance to patients. This may have led to some patients receiving suboptimal care. Thus, we proposed that hospital discharge planners need more information about the quality of home health agencies. Discharge planners should be more transparent about the quality of information they have, and they should help patients interpret it.

出院计划人员在帮助患者选择合适的家庭保健服务方面发挥着重要作用。然而,在COVID-19大流行期间,他们可能没有足够的信息来为患者做出最好的决定。一项对密歇根州医院58名出院计划人员的研究发现,其中90%的人想要了解家庭卫生机构的质量以及他们是否为COVID-19做好了准备。然而,只有大约20%的人可以随时获得这些信息。该研究还发现,出院计划者在纳入质量信息的方式上各不相同。有些根本没有纳入任何有质量的信息,而另一些则在没有解释其重要性的情况下提供给患者。只有约25%的出院计划人员帮助患者解读不同来源的信息。这些发现表明,医院出院计划人员对高质量信息的需求未得到满足,他们对患者的帮助也有限。这可能导致一些患者接受不理想的治疗。因此,我们建议出院计划人员需要更多关于家庭保健机构质量的信息。出院计划者应该对他们掌握的信息质量更加透明,他们应该帮助病人解读这些信息。
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引用次数: 0
Mental Health Reform Processes and Service Delivery Shift From the Hospital to the Community in Belgium and Hong Kong. 比利时和香港的精神卫生改革进程和服务由医院向社区的转变。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-09 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231211777
Mina Honyashiki, Jeroen Decoster, William Tak Lam Lo, Taichi Shimazu, Kentaro Usuda, Daisuke Nishi

Aim: We aimed to illustrate and compare the processes of mental health policies aiming at a service delivery shift from the hospital to the community using implementation science, and to identify important implementation strategies.

Methods: This study had a comparative case study design. The cases were the Belgian mental health reform, and the person-centered model of mental health in Hong Kong, China. Several documentary sources were reviewed, including the published literature and websites. Data on policy processes were extracted, analyzed using directed content analysis, and categorized into constructs of the conceptual model for evidence-informed policy formulation and implementation arranged for the mental health policy.

Results: Several similarities were identified in the strategies for active implementation and dissemination; official staff allocation, and training to the community psychiatric services, an approach to adjust the number of psychiatric hospital beds, and promoting collaboration between health care sectors and social welfare sectors. Under distinct social contexts, differences were found in all processes.

Conclusions: Each of the described policy processes can serve as a model for countries in similar social contexts seeking to shift their psychiatric service delivery. Furthermore, our findings suggest widely applicable implementation strategies for policies aiming at a service delivery shift.

目的:我们旨在利用实施科学说明和比较旨在从医院向社区提供服务的精神卫生政策的过程,并确定重要的实施策略。方法:本研究采用比较个案研究设计。以比利时精神卫生改革和中国香港以人为本的精神卫生模式为例。审查了若干文献来源,包括已发表的文献和网站。提取政策过程的数据,使用定向内容分析进行分析,并将其分类为为精神卫生政策安排的循证政策制定和实施的概念模型结构。结果:在积极实施和传播战略方面发现了若干相似之处;为社区精神病服务分配官方工作人员和培训,调整精神病医院病床数量,促进保健部门和社会福利部门之间的合作。在不同的社会背景下,各个过程都存在差异。结论:所描述的每个政策过程都可以作为具有类似社会背景的国家寻求转变其精神病学服务提供的模式。此外,我们的研究结果为旨在服务提供转变的政策提供了广泛适用的实施策略。
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引用次数: 0
Optimization of Care Pathways Through Technological, Clinical, Organizational and Social Innovations: A Qualitative Study. 通过技术、临床、组织和社会创新优化护理途径:一项定性研究。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-09 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231211096
Jean-Baptiste Gartner, André Côté

Numerous calls at national and international level are leading some countries to seek to redesign the provision of healthcare and services. Care pathways have the potential to improve outcomes by providing a mechanism to coordinate care and reduce fragmentation and ultimately costs. However, their implementation still shows variable results, resulting in them being considered as complex interventions in complex systems. By mobilizing an emerging approach combining action research and grounded theory methodology, we conducted a pilot project on care pathways. We used a strongly inductive process, to mobilize comparison and continuous theoretical sampling to produce theories. Forty-two interviews were conducted, and participant observations were made throughout the project, including 60 participant observations at meetings, workshops and field observations. The investigators kept logbooks and recorded field notes. Thematic analysis was used with an inductive approach. The present model explains the factors that positively or negatively influence the implementation of innovations in care pathways. The model represents interactions between facilitating factors, favourable conditions for the emergence of innovation adoption, implementation process enablers and challenges or barriers including those related specifically to the local context. What seems to be totally new is the embodiment of the mobilizing shared objective of active patient-partner participation in decision-making, data collection and analysis and solution building. This allows, in our opinion, to transcend professional perspectives for the benefit of patient-oriented results. Finally, the pilot project has created expectations in terms of spread and scaling. Future research on care pathway implementation should go further in the evaluation of the multifactorial impacts and develop a methodological framework of care pathway implementation, as the only existing proposition seems limited. Furthermore, from a social science perspective, it would be interesting to analyse the modes of social valuation of the different actors to understand what allows the transformation of collective action.

在国家和国际一级发出的众多呼吁正促使一些国家设法重新设计保健和服务的提供。通过提供一种协调护理和减少碎片化并最终降低成本的机制,护理途径有可能改善结果。然而,它们的实施仍然显示出不同的结果,导致它们被认为是复杂系统中的复杂干预。通过动员一种结合行动研究和扎根理论方法的新兴方法,我们开展了一个关于护理途径的试点项目。我们使用了强烈的归纳过程,动员比较和连续的理论抽样来产生理论。在整个项目期间进行了42次面谈,并进行了参与者观察,包括在会议、讲习班和实地观察中进行了60次参与者观察。调查人员保存日志并记录现场笔记。主题分析采用归纳方法。本模型解释了积极或消极影响护理途径创新实施的因素。该模型代表了促进因素、创新采用的有利条件、实施过程的推动因素和挑战或障碍(包括与当地环境具体相关的挑战或障碍)之间的相互作用。在决策、数据收集和分析以及解决方案制定方面,患者与合作伙伴积极参与这一动员共同目标的体现似乎是全新的。在我们看来,这可以超越专业的观点,以患者为导向的结果。最后,试点项目在传播和规模方面创造了期望。未来的研究应进一步评估护理路径实施的多因素影响,并建立一个护理路径实施的方法框架,因为现有的唯一命题似乎有限。此外,从社会科学的角度来看,分析不同行动者的社会评价模式,以了解是什么促成了集体行动的转变,这将是很有趣的。
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引用次数: 0
Does India's Zero by 30 Strategic Plan Need the Addition of the Rabies Vaccine to the Universal Immunisation Programme? 印度的“到30年清零”战略计划是否需要在全民免疫计划中增加狂犬病疫苗?
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-30 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231207930
Sahjid Mukhida, Nikunja Kumar Das, Deepu Palal, Prerna Verma, S Johnson
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引用次数: 0
Screening for Cystic Fibrosis Related Complications in the Context of a Pandemic and Altered Models of Care. 在大流行病和改变护理模式的背景下筛查囊性纤维化相关并发症。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231205145
Michael Doumit, Roxanne Strachan, Raynuka Lazarus, Peter Middleton, Ruth Dentice, Jessica Marouvo, Laura Jeffrey, Hiran Selvadurai, Sheila Sivam, Verity Pacey, Adam Jaffe, Kelly Gray

Background: Standard of care recommend that patients with cystic fibrosis (CF) require screening investigations to assess for complications. Changing models of care due to the COVID19 pandemic may have impacted completion of recommended screening.

Objective: To compare the frequency of screening investigations completed in people with CF before and after the onset of the COVID19 pandemic.

Methods: Medical records were reviewed at 4 CF-specialist centers to identify screening investigations completed in the 12-months before and after pandemic onset.

Results: Records of 625 patients were reviewed. Prior to pandemic onset, there was between center variability in completion of screening investigations. There was greatest baseline variation between centers in performing oral glucose tolerance test (OGTT); range 38%-69%, exercise tests; 3%-51% and sputum screening for non-tuberculous mycobacteria; 53%-81%. Following pandemic onset, blood tests, and sputum cultures were maintained at the highest rates. Exercise testing, CXR and OGTT exhibited the greatest declines, with reductions at individual centers ranging between 10%-24%, 22%-43%, and 20%-26%, respectively. Return to in-person visits following pandemic onset was variable, ranging from 16% to 74% between centers.

Conclusion: Completion of screening investigations varies between CF centers and changes in models of care, such as increased virtual care in response to COVID19 pandemic was associated with reduction in completion of investigations. Centers would benefit from auditing their adherence to standards of care, particularly considering recent changes in care delivery.

背景:护理标准建议囊性纤维化(CF)患者需要进行筛查以评估并发症。新冠肺炎疫情导致的护理模式变化可能影响了建议筛查的完成。目的:比较新冠肺炎疫情爆发前后CF患者完成筛查调查的频率。方法:对4个CF专家中心的医疗记录进行审查,以确定在大流行爆发前后12个月内完成的筛查调查。结果:回顾了625例患者的病历。在新冠疫情爆发之前,在完成筛查调查方面存在中心之间的变异性。在进行口服葡萄糖耐量试验(OGTT)时,各中心之间的基线差异最大;范围38%-69%,运动测试;3%-51%,痰中非结核分枝杆菌筛查;53%~81%。疫情爆发后,血液检测和痰培养保持在最高水平。运动测试、CXR和OGTT的下降幅度最大,单个中心的下降幅度分别在10%-24%、22%-43%和20%-26%之间。在新冠疫情爆发后,亲自就诊的比例各不相同,各中心之间的比例从16%到74%不等。结论:CF中心的筛查调查完成情况各不相同,护理模式的变化,如应对新冠肺炎疫情而增加的虚拟护理19,与调查完成情况的减少有关。中心将从审计其对护理标准的遵守情况中受益,特别是考虑到最近护理服务的变化。
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引用次数: 0
Multidisciplinary Team Meeting in the Core of Nasopharyngeal Cancer Management Improved Quality of Care and Survival of Patients. 癌症管理核心多学科团队会议提高了患者的护理质量和生存率。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-10-16 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231204757
Kartika W Taroeno-Hariadi, Camelia Herdini, Aulia S Briliant, Henry K Husodoputro, Wigati Dhamiyati, Sagung Rai Indrasari, Setiyani P Lestari, Yulestrina Widyastuti, Herindita Puspitaningtyas, Risa Rahmasari, Innayah Nur Rachmawati, Ibnu Purwanto, Nurhuda H Setyawan, Ericko Ekaputra, Susanna H Hutajulu, Sri R Dwidanarti, Torana Kurniawan, Lidya Meidania, Seize E Yanuarta, Mardiah S Hardianti, Johan Kurnianda

Nasopharyngeal cancer (NPC) cases are often diagnosed in advanced stages. The complexity of clinical management for advanced-stage NPC requires thorough communication and shared decisions between medical professionals and allied teams. Incorporating a multidisciplinary team meeting (MDTM) for newly diagnosed NPC patients was chosen to facilitate collaboration and communication between physicians. This retrospective study aimed to compare the quality of care, clinical responses and survival between NPC patients treated with and without MDTM. Data on clinical responses, assessment visits, date of progression and death with progression-free survival (PFS), overall survival (OS), and hazard ratio (HR) were collected and analyzed with 95% confidence interval (CI) and significance set as P < .05. There were 87 of 178 NPC patients treated with MDTM. Revisions of diagnosis and stage occurred in 5.7% and 52.9% of cases during the MDTM. More clinical responses were achieved by patients treated with MDTM (69.0%vs 32.0%, P < .00). NPC patients who received MDTM treatment recommendation had a lower risk for progression (median PFS 59.89 months vs 12.68 months; HR 0.267, 95% CI: 0.17-0.40, P < .00) and mortality (median OS was not reached vs 13.44 months; HR 0.134, 95% CI: 0.08-0.24, P < .00) compared to patients without MDTM. Incorporating the MDTM approach into NPC management improves patients' clinical responses and survival.

癌症病例通常诊断为晚期。晚期鼻咽癌临床管理的复杂性要求医疗专业人员和联合团队之间进行彻底的沟通和共享决策。选择为新诊断的NPC患者举办多学科团队会议(MDTM),以促进医生之间的合作和沟通。这项回顾性研究旨在比较使用和不使用MDTM治疗的NPC患者的护理质量、临床反应和生存率。收集并分析临床反应、评估访视、无进展生存期(PFS)、总生存期(OS)和危险比(HR)的进展和死亡数据,95%置信区间(CI)和显著性设置为P P P P
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引用次数: 0
Tracking Needs-Based Community and Specialized Services of Young Adults and Their Parents Before and During a First Episode of Psychosis (FEP): Highlighting Intervention Trajectories in FEP. 在首次精神病发作之前和期间跟踪年轻人及其父母基于需求的社区和专业服务:强调精神病发作的干预轨迹。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-09-30 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231200707
Marie-Hélène Morin, Maryse Proulx

Aim: This article aims to document 10 service trajectories of young adults (YA) and their parents, informed by healthcare professionals (HP), before and during a first episode of psychosis (FEP).

Design: Based on a crisis model perspective of the Life Course Theory (Elder; Elder and Shanahan) developed by Carpentier and White, and adapted to the current context to track community and specialized services trajectories. Thematic analysis was used to code responses to open-ended questions around the need for help and accessing services by young adults affected by a psychotic disorder, and their parents.

Setting: In collaboration with FEP clinics, setting of choice by YA and their parents.

Participants: 5 YA, 12 parents, and 6 HP.

Results: 10 individual service trajectories grouped into 3 distinct types of trajectories (optimal, typical, and complex) based on grouping 5 similar characteristics, highlighting service access complexity and early intervention in FEP.

Conclusion: This study is the first of its kind to examine the experiences of those who seek needs-based community and specialized services leading up to and during a FEP. Findings provide key insights related to early intervention in FEP and recommendations on improving access to such services in Quebec.

目的:本文旨在记录年轻人(YA)及其父母在精神病(FEP)第一次发作前和发作期间的10条服务轨迹。设计:基于Carpentier和White开发的生命历程理论(Elder;Elder和Shanahan)的危机模型视角,并适应当前环境,以跟踪社区和专业服务的轨迹。主题分析用于编码对受精神障碍影响的年轻人及其父母对帮助和获得服务的需求等开放式问题的回答。设置:与FEP诊所合作,由YA及其父母选择设置。参与者:5名YA、12名父母和6名HP。结果:10个个体服务轨迹基于5个相似特征分组,分为3种不同类型的轨迹(最优、典型和复杂),强调了FEP中服务获取的复杂性和早期干预。结论:本研究首次考察了那些在FEP之前和期间寻求基于需求的社区和专业服务的人的经历。研究结果提供了与FEP早期干预相关的关键见解,并就改善魁北克获得此类服务的机会提出了建议。
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引用次数: 0
The Patient as an Actor in His Care Pathway: Insights From the French Case. 患者在其护理路径中扮演的角色:法国案例的启示。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-09-28 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231196029
Isabelle Aubert, Frédéric Kletz, Jean-Claude Sardas

In France, patients' right to take part in decisions regarding their health has been recognized by law since 2002. This legal recognition was the outcome of a long-standing call to allow all individuals to be "actors in their own health" and to co-develop their care pathway with the professionals involved. In practice, care pathways simultaneously intertwine both standardization and personalization dynamics, which involve different forms of professional-patient interaction. This article analyses the links between the organizational variables of care pathways, and the ways in which patients are involved in the management of their own pathway. To date, these links have received little attention in the management science and health literatures. We draw on material from a case study carried out in 2 French territories, combining the analysis of patient pathways with interviews conducted with professionals and carers. Building on this analysis, we propose a typology of patient profiles which distinguishes between their different forms of involvement in the development of their care pathway, based on its organizational characteristics.

在法国,自2002年以来,法律承认患者参与健康决策的权利。这一法律承认是一项长期呼吁的结果,即允许所有人都成为“自己健康的参与者”,并与相关专业人员共同发展他们的护理途径。在实践中,护理途径同时交织着标准化和个性化动态,这涉及不同形式的专业患者互动。本文分析了护理路径的组织变量与患者参与自身路径管理的方式之间的联系。到目前为止,这些链接在管理科学和健康文献中很少受到关注。我们借鉴了在2 法国领土,将对患者路径的分析与对专业人员和护理人员进行的访谈相结合。基于这一分析,我们提出了一种患者档案类型,根据其组织特征,区分他们参与护理途径发展的不同形式。
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Health Services Insights
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