BMJ open:多重疾病患者的照护质量:对患者及其亲属的焦点小组研究

2021
06/29

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BMJ open

多重疾病患者的照护质量:对患者及其亲属的焦点小组研究

 



摘要

背景

患有多种疾病的人的患病率上升。多发病对医疗保健系统构成挑战,多发病患者的治疗容易出现变化。目前,还没有一套质量指标 (QI) 来评估照护质量,更不用说结合患者的观点了。因此,我们的目标是确定与患者观点相关的照护质量,并将它们与基于文献的 QI 集相匹配。

方法

我们使用半结构化指南对患有多种疾病的患者进行了八个焦点小组访谈,并与患者亲属进行了三个焦点小组访谈。使用Kuckartz 的定性内容分析来分析数据。我们从文献中推导出演绎类别,添加归纳类别(新的质量方面)并将它们翻译成 QI。

结果

我们根据与患者/亲属相关的质量方面创建了四个新的 QI。两个 QI(患者教育/自我管理、药物计划的定期更新)得到专家小组的同意,而另外两个 QI(定期检查、全科医生协调的照护)没有得到同意。一半基于文献的 QI,例如对生物心理社会支持需求的评估,得到了参与者的支持,而焦点小组中没有涉及更多关于评估和治疗方案的技术领域。

结论

我们表明,患者和亲属在 QI 发展中,添加相关方面的焦点小组应默认纳入 QI 发展过程,并构成对传统 QI 发展的合理补充。我们的 QI 集构成了评估德国医疗保健系统照护质量的框架。它将促进治疗标准的实施并增加对现有指南的使用,从而有助于减少医疗资源在多发病患者治疗中的过度使用、使用不足和滥用。


Abstract

Background Prevalence of people with multimorbidity rises. Multimorbidity constitutes a challenge to the healthcare system, and treatment of patients with multimorbidity is prone to high-quality variations. Currently, no set of quality indicators (QIs) exists to assess quality of care, let alone incorporating the patient perspective. We therefore aim to identify aspects of quality of care relevant to the patients’ perspective and match them to a literature-based set of QIs.

Methods We conducted eight focus groups with patients with multimorbidity and three focus groups with patients’ relatives using a semistructured guide. Data were analysed using Kuckartz’s qualitative content analysis. We derived deductive categories from the literature, added inductive categories (new quality aspects) and translated them into QI.

Results We created four new QIs based on the quality aspects relevant to patients/relatives. Two QIs (patient education/self-management, regular updates of medication plans) were consented by an expert panel, while two others were not (periodical check-ups, general practitioner-coordinated care). Half of the literature-based QIs, for example, assessment of biopsychosocial support needs, were supported by participants’ accounts, while more technical domains regarding assessment and treatment regimens were not addressed in the focus groups.

Conclusion We show that focus groups with patients and relatives adding relevant aspects in QI development should be incorporated by default in QI development processes and constitute a reasonable addition to traditional QI development. Our QI set constitutes a framework for assessing the quality of care in the German healthcare system. It will facilitate implementation of treatment standards and increase the use of existing guidelines, hereby helping to reduce overuse, underuse and misuse of healthcare resources in the treatment of patients with multimorbidity.






原文链接:

https://bmjopen.bmj.com/content/11/6/e047025



本文由作者自行上传,并且作者对本文图文涉及知识产权负全部责任。如有侵权请及时联系(邮箱:nanxingjun@hmkx.cn
关键词:
患者,亲属,疾病,照护

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