肝病作为协议化初级保健背景下的新工作 - - 一般医生有没有作用? 一个定性面试研究研究
Helen G Jarvis1, Tom Sanders2, Barbara Hanratty1
1Newcastle University.
概括
将肝病管理纳入初级保健是具有挑战性的,因为预先定义的目标. 如果不包括在激励计划中,肝病护理不太可能成为初级保健机构的常规.
科学领域:
- 主要护理医学 医疗保健
- 肝病学 肝病学是一种肝病学.
- 医疗保健服务研究 医疗服务研究
背景情况:
- 肝脏疾病是一个普遍的疾病.
- 目前的初级保健实践并没有定期整合慢性肝病管理.
- 现有的慢性疾病管理框架是高度规范的.
研究的目的:
- 调查实施肝病护理途径的障碍.
- 了解初级保健的结构化系统中的整合挑战.
- 探索卫生专业人员对管理肝病的观点.
主要方法:
- 与20名初级保健卫生专业人员进行了半结构化采访.
- 利用规范化过程理论 (NPT) 和边界理论来为面试提供信息.
- 采用专题分析来解释数据.
主要成果:
- 确定了三个关键主题:定义,需要和价值,以及慢性疾病管理中的角色.
- 专业人员的角色和工作价值是由国家激励目标决定的.
- 结构性约束限制了职业自主权和管理肝脏疾病等新疾病的能力.
结论:
- 缺乏对护理决策的影响,挑战了专业界限.
- 肝病管理很可能会在常规初级保健之外,除非它被纳入现有的目标驱动系统.
- 将肝病纳入初级保健需要与当前的绩效指标和激励结构保持一致.
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