了解初级保健缺失的原因:一个现实主义的审查
Calum Lindsay1, David Baruffati2, Mhairi Mackenzie3
1General Practice and Primary Care, School of Health and Wellbeing, University of Glasgow, Clarice Pears Building, 90 Byres Road, Glasgow, G12 8TB, UK. calum.lindsay@glasgow.ac.uk.
了解为什么患者反复错过初级保健预约至关重要. 错过多次预约的原因是复杂的患者和系统因素,导致健康不平等.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 公共卫生 公共卫生
- 健康的社会经济决定因素
背景情况:
- 错过的医疗保健预约是政策和实践的一个重大问题.
- 现有的研究主要针对单一的,局面性错过预约,忽视持久的,多次错过预约.
- 多次错过预约对健康不平等的影响仍未得到充分研究.
研究的目的:
- 探索在初级保健中承受多次错过预约的原因.
- 了解多次错过预约在产生健康不平等方面的作用.
主要方法:
- 对197篇关于多次错过预约的论文进行了现实主义的审查.
- 在多个数据库和灰色文献中进行搜索,并进行引用跟踪.
- 综合使用候选和基本因果关系的理论框架的证据.
主要成果:
- 错过多次预约的原因是相互关联的因素:患者对需要的感知,沟通不良,权力不平衡,竞争优先事项,旅行/移动问题以及缺乏灵活性.
- 这些因素造成了进入和参与初级保健服务的障碍.
- 这些障碍的累积效应有助于健康不平等.
结论:
- 干预措施必须有理论依据,并根据个体患者的需要和障碍量身定制.
- 在各个层面解决多个因果领域对于有效的干预是必不可少的.
- 干预措施应优先考虑患者安全,并旨在增加那些错过预约的患者获得护理的机会.
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