"就像一把伞,为我遮风挡雨,直到我到达目的地":评估为城市边缘人群量身定制的初级保健模式的实施情况。

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Soha Khorsand, Carol Geller, Alison Eyre, Hounaida Abi Haidar, Haifeng Chen, Corina Lacombe, Monisha Kabir, Andrew Mclellan
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引用次数: 0

摘要

背景:提高健康公平性和尽可能获得最高标准的医疗保健是社会责任的一个关键问题。自 1999 年以来,加拿大渥太华的 Centretown 社区健康中心反复制定了一项计划,以边缘化和复杂人群为目标并为其提供服务。该计划的实施采用了一个经过验证的实施框架进行评估:方法:通过健康记录提取(570 人)、客户复杂性评估工具(74 人)、对客户和主要利益相关者的半结构化访谈(41 人)以及结构化客户满意度调查(30 人)收集定量和定性数据。采用描述性统计和归纳主题分析法对数据进行分析:在 2021 年 11 月 1 日至 30 日期间,共接待了 570 名客户。三分之一的客户(34%)没有省健康卡,无法享受全民医疗保健服务,大多数客户(68%)是无家可归者或寄宿家庭的居民。大多数报告收入的患者(92%)处于或低于加拿大官方规定的贫困线。在一个月的就诊时间内(n = 74),客户的复杂性总平均值为 16.68(标准差 6.75),在 33 项评分中,总分至少达到 13 分被视为客户生物心理社会复杂性的临界值。服务对象的总分大部分来自工具中的社会支持评估部分。客户(31 人)和主要信息提供者(10 人)强调了与这一人群建立关系、提供全方位护理和低障碍护理的重要性,认为这是城市健康计划(UH)的主要优势。需要改进的关键领域包括:i) 增加工作人员的多样性;ii) 增加项目时间和可用性;iii) 增加获得减低伤害服务的机会。服务对象似乎对该计划非常满意,他们对该计划的平均总评分为 18.50 分(满分 20 分):该项目为边缘化和复杂的客户提供服务,似乎深受社区欢迎。我们的研究结果对其他医疗机构也有借鉴意义,这些机构都希望更好地为社区中的边缘化、在医疗和社会方面情况复杂的个人和家庭提供服务。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

Background: Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework.

Methods: Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis.

Results: Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20.

Conclusions: The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

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