解决守门员难题:患者在初级保健中所重视的价值以及向专家推
K Grumbach1, J V Selby, C Damberg
1Department of Family and Community Medicine, Primary Care Research Center, University of California, San Francisco, USA. keving@itsa.ucsf.edu
JAMA
|July 28, 1999
概括
患者高度重视初级保健医生 (PCP) 作为第一接触提供者和转诊协调员. 然而,限制专家访问的守门员政策削弱了患者对PCP的信任和信心.
科学领域:
- 医疗保健政策 医疗保健政策
- 初级医疗保健医学 一级医疗保健医学
- 患者的满意度 患者的满意度
背景情况:
- 关于患者对初级保健医生 (PCP) 在管理护理中的守门员角色的看法,数据有限.
- 了解患者的观点对于优化医疗保健提供和管理护理系统至关重要.
研究的目的:
- 评估PCP作为第一接触提供者和推协调员的患者评价.
- 确定患者是否认为PCP是专家访问的障碍.
- 检查推访问问题与患者对PCP的信任之间的关联.
主要方法:
- 1997年,在加利福尼亚州的7718名成年托管护理成员中进行了一项横截面调查.
- 调查问卷评估了患者对PCP角色的态度,医生评级 (信任,信心,满意度) 以及感知到的转诊障碍.
- 统计分析检查了转诊障碍作为患者医生评级的预测因素.
主要成果:
- 超过90%的患者对PCP的首次接触和转诊协调进行了评估.
- 75%-91%的人更喜欢PCP的初始护理而不是专家.
- 23%的人报告说,PCP阻碍了专家的访问.
- 难以获得推与较低的信任 (OR 2.7),信心 (OR 2.2) 和满意度 (OR 3.3) 相相关.
结论:
- 患者非常重视PCP在管理他们的护理中的综合作用.
- 管理护理守门员政策限制专家访问,对患者对PCP的信任和信心产生负面影响.
- 将管理护理政策与患者偏好重新调整可能会加强PCP-PC关系.
相关概念视频
01:08Obedience
According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation, obedience...
01:26Standard Precaution
Standard precautions are the minimum infection control safeguards used while caring for all patients, irrespective of their disease condition. They help prevent the spread of common infectious microorganisms to healthcare workers, patients, and visitors in all healthcare settings.
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
01:21Planning Nursing Care I
The planning phase of the nursing process helps nurses set priorities, outline patient-centered goals and expected outcomes, and tailor nursing interventions to align with the aligned care plan. Through the planning phase, the nurse applies critical thinking skills to align and develop interventions according to the patient's needs. It provides continuity of care allowing patients to receive the maximum benefit from treatment. It serves as a pilot plan for allocating individual staff to a...
01:17Ethical Dilemmas I
Ethical dilemmas in nursing are of utmost importance, as they often arise from the tension between adhering to core ethical principles and the practical realities of healthcare delivery. These dilemmas require nurses to navigate complex situations where competing ethical considerations pull them in different directions.
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...
Let us explore some examples to understand the potentially complex moral decisions nurses face.
Take the case of caring for minors, particularly in areas related to reproductive...
01:30Pneumonia III: Complications and Assessment
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
01:30Pneumonia V: Nursing management and Prevention
Nursing management of pneumonia involves promoting airway patency, facilitating rest and conserving energy, encouraging fluid intake, maintaining nutrition, and educating patients.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.