全科医生对多病患者的思考和经验:一项定性研究

L. Ørtenblad, N. Nissen
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引用次数: 7

摘要

引言全科医生对多发病患者的管理大多被描述为一种负担,尽管也有人指出,全科医生的基本特征非常适合对多发病进行适当的管理。然而,对全科医生的实际做法知之甚少。本研究探讨了全科医生对多发病患者的管理。方法采用参与者观察和访谈的定性方法设计。解释性描述被用作分析框架。这项研究是在丹麦的一个省城进行的。三家全科诊所共有12名全科医生参加。结果“多发病”作为一个通用术语并不能反映全科医生的实践。他们的方法是基于个体患者的功能能力。该组的异质性被分为三类,决定了全科医生的方法:功能良好的患者、令人惊讶的患者和脆弱的患者。三个核心特征被确定为全科医生方法的关键:对患者情况的整体看法、以患者为中心的关注以及协调员和促进者。这些是全科医学的基本特征,但由于它们适应了多发性疾病患者的复杂性和异质性,因此变得尤为重要。讨论本研究通过探索全科医生的实际实践扩展了主题领域,从而为支持多发病患者的适当管理的特征提供了新的视角。全科医生在考虑多发病患者的异质性和复杂性时,平衡了行政和临床法规。这表明,必须提供更好的可能性来实现全科医学的基本特征,以支持他们对多发病患者的管理。
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General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study
Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.
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来源期刊
CiteScore
3.10
自引率
14.30%
发文量
15
期刊介绍: The International Journal of Care Coordination (formerly published as the International Journal of Care Pathways) provides an international forum for the latest scientific research in care coordination. The Journal publishes peer-reviewed original articles which describe basic research to a multidisciplinary field as well as other broader approaches and strategies hypothesized to improve care coordination. The Journal offers insightful overviews and reflections on innovation, underlying issues, and thought provoking opinion pieces in related fields. Articles from multidisciplinary fields are welcomed from leading health care academics and policy-makers. Published articles types include original research, reviews, guidelines papers, book reviews, and news items.
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