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目的初级医疗医生在复杂患者的治疗中起到独特作用,通常作为患者治疗的中心在各专科医生之间进行协调。为了推广复杂患者治疗新模式的临床应用,我们对初级医疗医生如何定义和分类患者复杂性进行调查。方法对隶属于高校附属医院和社区医院的5家诊所内科初级医疗医生进行定性深度访谈。采用系统非概率抽样法,得到性别、行医年份和行医种类均匀分布的样本。采用基于团队的参与综合归纳法对访谈结果进行分析。结果 15名医生对患者复杂性进行多维度定义。医生们认为如果患者具有一项使慢性病治疗复杂化的恶化因素,则该患者具有复杂性。这些恶化因素包括内科疾病、精神疾病、社会经济挑战、某种行为或者特性(或者上述因素的结合)。结论了解治疗复杂患者初级医疗医生的观点有助于优化患者复杂性处理模式,从而设计干预方法或治疗模式,进而改善此类患者结局。
Purpose The primary care physician plays a unique role in the treatment of complex patients and is often coordinated among the specialists as the center of patient treatment. To promote the clinical application of the new paradigm for the treatment of complex patients, we investigated how primary care physicians define and classify patient complexities. Methods Qualitative and in-depth interviews were conducted with five primary medical physicians affiliated to the affiliated hospitals and community hospitals in colleges and universities. The system non-probability sampling method was used to get the samples with uniform distribution of sex, practice year and practice type. The interview results were analyzed using a team-based participatory induction. Results Fifteen doctors performed a multidimensional definition of patient complexity. Doctors think the patient is complex if the patient has a deteriorating factor that complicates the treatment of chronic diseases. These deteriorating factors include medical conditions, mental illness, socioeconomic challenges, certain behaviors or traits (or a combination of these). Conclusion Understanding the views of treating primary care physicians in complex patients helps to optimize the pattern of patient complexity to design interventions or treatment modalities to improve outcome in such patients.