Development of a person-centred care approach for persons with chronic multimorbidity in general practice by means of participatory action research

IF 3.2 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Mieke JL Bogerd, Pauline Slottje, Jettie Bont, Hein PJ Van Hout
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引用次数: 0

Abstract

The management of persons with multimorbidity challenges healthcare systems tailored to individual diseases. A person-centred care approach is advocated, in particular for persons with multimorbidity. The aim of this study was to describe the co-creation and piloting of a proactive, person-centred chronic care approach for persons with multimorbidity in general practice, including facilitators and challenges for successful implementation. A participatory action research (PAR) approach was applied in 13 general practices employing four subsequent co-creation cycles between 2019 and 2021. The target population included adults with ≥3 chronic conditions. Participating actors were general practitioners (GPs), practice nurses (PNs), patients (target group), the affiliated care cooperation, representatives of a health insurer and researchers. Each cycle consisted of a try-out period in practice and a reflective evaluation through focus groups with healthcare providers, interviews with patients and analyses of routine care data. In each cycle, facilitators, challenges and follow-up actions for the next cycle were identified. Work satisfaction among GPs and PNs was measured pre and at the end of the final co-creation cycle. Identified essential steps in the person-centred chronic care approach include (1) appropriate patient selection for (2) an extended person-centred consultation, and (3) personalised goalsetting and follow-up. Key facilitators included improved therapeutic relationships, enhanced work satisfaction for care providers, and patient appreciation of extended time with their GP. Deliberate task division and collaboration between GPs and PNs based on patient, local setting, and care personnel is required. Challenges and facilitators for implementation encompassed a prioritisation tool to support GPs appropriately who to invite first for extended consultations, appropriate remuneration and time to conduct extended consultations, training in delivering person-centred chronic care available for all general practice care providers and an electronic medical record system accommodating comprehensive information registration. A person-centred chronic care approach targeting patients with multimorbidity in general practice was developed and piloted in co-creation with stakeholders. More consultation time facilitated better understanding of persons’ situations, their functioning, priorities and dilemma’s, and positively impacted work satisfaction of care providers. Challenges need to be tackled before widespread implementation. Future evaluation on the quadruple aims is recommended.
通过参与式行动研究,为全科医生中的慢性多病患者制定以人为本的护理方法
对多病症患者的管理对针对个别疾病的医疗保健系统提出了挑战。人们提倡以人为本的护理方法,尤其是针对多病患者的护理方法。本研究的目的是描述在全科实践中为多病患者共同创建和试行以人为本的主动式慢性病护理方法的情况,包括成功实施的促进因素和挑战。在2019年至2021年期间,13家全科诊所采用了参与式行动研究(PAR)方法,随后又进行了四个共创周期。目标人群包括患有≥3 种慢性疾病的成年人。参与者包括全科医生(GPs)、执业护士(PNs)、患者(目标群体)、附属医疗合作机构、医疗保险公司代表和研究人员。每个周期包括一个实践试用期,以及通过与医疗服务提供者的焦点小组、与患者的访谈和对常规护理数据的分析进行的反思性评估。在每个周期中,都确定了下一周期的促进因素、挑战和后续行动。在最后一个共创周期结束前和结束时,对全科医生和全科护士的工作满意度进行了测量。已确定的以人为本的慢性病护理方法的基本步骤包括:(1)适当选择病人;(2)以人为本的扩展咨询;(3)个性化目标设定和后续行动。关键的促进因素包括改善治疗关系、提高护理提供者的工作满意度以及患者对延长全科医生诊治时间的赞赏。全科医生和初级护士之间需要根据患者、当地环境和护理人员的情况进行有意的任务分工与合作。实施过程中遇到的挑战和促进因素包括:为全科医生提供优先顺序工具,以帮助他们合理安排首先邀请哪些人进行延长会诊;提供适当的报酬和时间以进行延长会诊;为所有全科医生提供以人为本的慢性病护理培训;以及提供可进行全面信息登记的电子病历系统。在与利益相关者共同创造的过程中,针对全科多发病患者开发并试行了以人为本的慢性病护理方法。更多的咨询时间有助于更好地了解患者的情况、功能、优先事项和困境,并对护理提供者的工作满意度产生积极影响。在广泛实施之前,需要应对各种挑战。建议今后对四重目标进行评估。
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来源期刊
BMC Family Practice
BMC Family Practice 医学-医学:内科
CiteScore
3.20
自引率
0.00%
发文量
0
审稿时长
4-8 weeks
期刊介绍: BMC Family Practice is an open access, peer-reviewed journal that considers articles on all aspects of primary health care research. The journal has a special focus on clinical decision making and management, continuing professional education, service utilization, needs and demand, and the organization and delivery of primary care and care in the community.
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