超越障碍与推动者:医师主导创新利益驱动的定性研究

IF 2.1 4区 医学 Q3 HEALTH CARE SCIENCES & SERVICES
Miriam Wiersma, Ian Kerridge, Wendy Lipworth
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引用次数: 0

摘要

临床创新-医生开发和使用与标准实践有很大不同的新干预措施,并且尚未被证明在医疗保健系统中常规使用是足够安全或有效的-具有改变患者护理和推动医学进步的潜力。然而,这并非没有风险。因此,重要的是,决策者和卫生保健机构制定战略,鼓励负责任的临床创新。为了使这些策略有效,它们需要基于对推动医生开发和使用创新干预措施的因素的全面理解。虽然研究对情境障碍和促进因素提供了重要的见解,但个体因素,特别是医生的兴趣,仍未得到充分探索。目的和目的本定性研究的目的是调查不同医学专业推动和阻碍临床创新的因素,并检查这些因素在不同专业之间是否存在显著差异。方法对31名来自澳大利亚外科、生殖医学和癌症护理的医生进行半结构化访谈。结果医生的利益(例如,对患者的义务和个人财务问题)被认为在推动他们使用创新干预措施方面发挥着重要作用,同时还有个人特征和环境因素。不同专业之间也存在显著差异——与肿瘤学家相比,生育专家和外科医生更强调经济和商业利益是临床创新的关键驱动力。我们的研究结果表明,尽管在卫生系统层面解决临床创新的结构性障碍仍然很重要,但政策制定者也必须关注医生创新者的不同利益。了解这些利益、它们相互协调和冲突的方式,以及在不同专业中最突出的是什么,将使政策制定者和医疗机构能够制定有针对性的战略,鼓励医生主导的创新,并确保其负责任。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Beyond Barriers and Facilitators: A Qualitative Study of the Interests Driving Physician-Led Innovation

Rationale

Clinical innovation—where physicians develop and use novel interventions that differ significantly from standard practice and that have not been shown to be sufficiently safe or effective for regular use in healthcare systems—has the potential to transform patient care and drive medical advancement. However, it is not without risk.

It is important, therefore, that policymakers and healthcare institutions develop strategies to encourage responsible clinical innovation. For these strategies to be effective, they need to be based on a comprehensive understanding of the factors driving physicians' development and use of innovative interventions. While research has provided important insights into contextual barriers and facilitators, individual factors, particularly physicians' interests, remain underexplored.

Aims and Objectives

The aims of this qualitative study were to investigate the factors that drive and deter clinical innovation in diverse medical specialties and to examine whether these factors differ significantly between specialties.

Method

Thirty-one semi-structured interviews were conducted with Australian physicians from surgery, reproductive medicine, and cancer care.

Results

Physicians' interests (e.g., obligations to patients and personal financial concerns) were perceived to play an important role in driving their use of innovative interventions, along with individual traits and contextual factors. There were also significant differences between specialties—with fertility specialists and surgeons more strongly emphasizing financial and commercial interests as key drivers of clinical innovation than oncologists.

Conclusions

Our findings suggest that while addressing structural barriers to clinical innovation at the health system level remains important, policymakers must also give attention to the diverse interests of physician-innovators. Understanding these interests, the ways in which they align and conflict, and which are most prominent across different specialties, will enable policymakers and healthcare institutions to develop targeted strategies to encourage physician-led innovation and ensure it is responsible.

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来源期刊
CiteScore
4.80
自引率
4.20%
发文量
143
审稿时长
3-8 weeks
期刊介绍: The Journal of Evaluation in Clinical Practice aims to promote the evaluation and development of clinical practice across medicine, nursing and the allied health professions. All aspects of health services research and public health policy analysis and debate are of interest to the Journal whether studied from a population-based or individual patient-centred perspective. Of particular interest to the Journal are submissions on all aspects of clinical effectiveness and efficiency including evidence-based medicine, clinical practice guidelines, clinical decision making, clinical services organisation, implementation and delivery, health economic evaluation, health process and outcome measurement and new or improved methods (conceptual and statistical) for systematic inquiry into clinical practice. Papers may take a classical quantitative or qualitative approach to investigation (or may utilise both techniques) or may take the form of learned essays, structured/systematic reviews and critiques.
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