与健康相关的社会需求在初级保健中的讨论在安全网诊所的遭遇:定性分析
Elaine De Leon1,2, Sneha Panganamamula1, Antoinette Schoenthaler2
1Department of Medicine, NYU Langone Health, New York, New York.
JAMA network open
|March 26, 2025
概括
临床医生经常开始讨论物质使用,体力活动和心理健康,而患者则引入了财务压力. 需要标准化查和培训,以有效地解决与健康相关的社会需求 (HRSN).
科学领域:
- 医疗保健服务研究 医疗服务研究
- 初级医疗保健医学 一级医疗保健医学
- 质量健康研究 质量健康研究
背景情况:
- 与健康相关的社会需求 (HRSN) 对患者的健康结果和医疗保健利用有重大影响.
- 临床医生在解决HRSN方面遇到挑战,原因是技能,专业知识和时间的限制.
- 了解患者和临床医生在临床接触中对HRSN的导航至关重要.
研究的目的:
- 检查在门诊初级保健接触中,关于健康相关社会需求 (HRSN) 的讨论是如何启动和解决的.
- 在广泛实施查之前,在安全网诊所设置中描述HRSN讨论的内容和性质.
主要方法:
- 来自纽约市三个初级保健诊所的97个录音带患者与临床医生会面的定性分析.
- 接触涉及患有高血压的成年患者,自我认定为黑色或白色.
- 根据社会需求领域编码成绩单,讨论启动 (患者/临床医生) 和干预策略.
主要成果:
- 身体活动,财务压力,心理健康和物质使用是讨论最多的HRSN领域.
- 患者最常开始讨论的是财务压力,就业,粮食不安全和住房不稳定.
- 临床医生主要开始讨论物质使用,体力活动和心理健康;干预措施因领域而异.
结论:
- 临床医生倾向于开始讨论常规评估的行为,与患者介绍的主题不同,例如财务压力.
- 标准化查是必要的,以提高识别临床医生不经常解决的HRSN领域.
- 加强临床医师培训和综合护理团队方法对于改善资源有限的环境中HRSN识别和干预至关重要.
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