制定步骤,改善医护人员日常工作中的依从性

L. Lekić, E. Alibegović, Jasna Rahimić, Bojan Pavlović, Aida Hamzić-Mehmedbašić
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引用次数: 0

摘要

依从性是近来被突出使用和强调的一个术语,代表了病人与治疗之间的联系。医疗依从性有其等级结构,其根源主要来自立法机构、医疗系统、医疗机构以及最终的医疗专业人员(医生、护士、技术人员)。然而,许多患者,尤其是慢性病患者,在实现治疗目标和改善治疗效果方面,医疗依从性面临着巨大障碍。波斯尼亚和黑塞哥维那(波黑)的社会和社会条件以及国家组织在很大程度上影响着医疗保健系统和医疗保健服务使用者的购买力。由于在坚持治疗方面存在重大障碍和挑战,因此正在努力维持一个支持提高患者坚持治疗水平的系统。在本研究论文中,提出了三个值得商榷的论题:内部和外部教育、医疗保健系统的改进以及对患者依从性进行系统数据收集。所有三篇质疑论文都得到了受访者(200 名参与者)的积极反馈。第一份论文有 154 名受访者投了赞成票,第二份论文有 142 名受访者投了赞成票,第三份论文有 134 名受访者同意所提出的建议。遗憾的是,波黑没有充分重视患者的依从性,也没有统一的战略来提高依从性水平。内部和外部教育至关重要,因为医护人员没有得到充分的培训,也没有为实施教育创造条件。如果有足够的条件,提高依从性水平对医护人员的日常工作大有裨益。遗憾的是,相当多的医护人员缺乏如何提高患者依从性的知识、经验和明确的策略。测量依从性的复杂性只会让本已错综复杂的问题更加错综复杂,而医疗系统的低效和迟缓又阻碍了适当活动的开展,而这些活动应能提高患者的依从性。患者的依从性受到众多因素的影响,对此没有独特的解决方案或克服建议。此外,在识别和衡量依从性的过程中存在的问题也使得本已复杂的问题和提高用户依从性的过程变得更加复杂。在波斯尼亚和黑塞哥维那,几乎不可能在国家层面制定提高依从性的战略;因此,提高依从性只能在患者、医护人员层面实现,最好是在医疗机构层面。遗憾的是,在大多数情况下,医疗条件和工作量不允许医护人员有足够的时间与病人在一起,建立充分的沟通,并表明病人对他们真正重要。不仅要提供必要的护理,还要提供有关疾病和治疗的基本信息,这会直接影响病人的依从性。发达国家的医疗保健系统虽然在技术上是可行的,但缺乏适当的机制来收集、处理和分析与特定病情或特定地区患者依从性水平有关的数据。数据的收集往往采用间接方法,无法提供准确和精确的信息,这对证明医疗依从性在医疗系统和治疗结果中的作用和重要性构成了巨大挑战。考虑到医疗盲从率从 43% 到 78%不等,对于某些治疗方案来说过高,因此需要进行立法改革。除法律及其管理机构外,还必须确保向所有医疗机构、医院和保健中心提供从药品到特定医疗用品的所有必需品。内部和外部教育对病人的治疗至关重要,因此必须每月实施和开展。除医护人员外,考虑到患者可分为不熟悉使用现代技术进行自我教育和不了解遵医嘱的作用和意义的患者,因此对患者的教育也至关重要。此外,还有一些患者善于使用现代技术来研究自己的病情和治疗方案,但他们缺乏足够的知识和信息来评估现有数据的准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
DEVELOPING STEPS TO IMPROVE ADHERENCE IN HEALTHCARE PROFESSIONALS DAILY PRACTICE
Adherence is a a term that has been prominently used and emphasized recently, representing the connection between a patient and their treatment. Medical adherence has its hierarchical structure, with roots primarily stemming from legislative bodies to the healthcare system, institutions and ultimately healthcare professionals (doctors, nurses, technicians). However, medical adherence faces a significant obstacle in achieving therapy goals and improving treatment outcomes among many patients, especially those with chronic conditions. Social and sociental conditions, as well as the state organization in Bosnia and Herzegovina (BiH), greatly influence the healthcare system and the purchasing power of healthcare service users. Due to significant barriers and challenges regarding adherence, efforts are being made to maintain a system that supports increasing patient adherence levels. Within this research paper, three questionable theses are presented: internal and external education, improvement of the healthcare system and the implementation of systematic data collection on patient adherence. All three questionable thesis recived positive feedback from respondents (200 participants). From the first thesis, 154 respondents voted in favor, for the second thesis, 142 respondents and for the third thesis, 134 respondents agreed with the proposed suggestions. Unfortunately, in BiH insufficinet attention is given to patient adherence and there is no unified strategy to increase adherence levels. Internal and external education would be essential as healthcare workers are not adequately trained, nor are conditions created for its implementation. Increasing the level of adherence can greatly benefit healthcare workers in their daily practice if they have adequate conditions in place. Unfortunately, a significant number of healthcare employees lack the knowledge, experience and a clearly defined strategy on how to increase patient adherence. The complexity of measuring adherence only adds to the intricacy of an already complex problem and the inefficiency and sluggishness of the healthcare system hinder the creation of appropriate activities that should result in increased patient adherence. The patient’s adhrence is influenced by numerous factors for which there is no unique solution or overcoming suggestions. Also, problems in the process of identifying and measuring adherence further complicate the already complex matter and the process of increasing user adherence. Creating a strategy to improve adhrence at the state level in Bosnia and Herzegovina is almost impossible; therefore, the increase in adhrence can only be achived at the level of the patient, healthcare personnel and ideally, at the level of healthcare institutions. Unfortunately, in most cases, conditions and workload do not allow healthcare workers to spend enough time with patients, establish adequate communication and demonstrate that the patient is genuinely important to them. Providing not only the necessary care but also essential information about the illness and treatment can directly impact the level of patient adhrence. The healthcare system in developed countries, although technologically possible, lacks and adequate mechanism for collecting, processing and analyzing data related to the adherence level of patients with a specific condition or in a particular geographic region. Data is often collected based on indirect methods that do not provide accurate and precise information, posing a significant challenge in proving the role and importance of medical adhrence in the healthcare system and treatment outcomes. Considering that the adhrence level ranges from 43% to 78%, which is too high for certain treatment regimens, legislative reforms are needed. In addition to the law and its govering body, it is necssary to ensure all essential materials, from medications to specific medical supplies are provided to all healthcare institutions, hospitals and healthcare centres. Both internal and external education are crucial for patient treatment and therefore it sholud be implemented and carried out on a monthly basis. In addition to healthcare professionals, the education of patients with medical conditions is essential, considering they can be divided into those who are not familiar with using modern technologies to educate themselves and understand the role and significance of medical adherence. Moreover, there are patients who are adept at using modern tchnology to research their condition and treatment options, but they lack sufficinet knowledge and information to assess the accuracy of the available data.
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