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>Continuity and team approaches to care: Effects on physician -patient relationship quality, patients' experiences, and the technical quality of care.
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Continuity and team approaches to care: Effects on physician -patient relationship quality, patients' experiences, and the technical quality of care.
Team approaches to care are increasingly being considered critical to improving quality for patients with complex chronic conditions and for primary care practices in general. However, many studies demonstrate some benefit to structuring care so that individual provider visit continuity is a priority. The dissertation aims to better understand how various conditions influence team performance and the quality care delivered to patients.;Section 1 explores the effect of multidisciplinary primary care teams on patients' experiences with care. Higher physician continuity was associated with more favorable patients' experiences. An exception was patients' assessments of teams, which were better when on- vs. off-team visits occurred. For other measures, the decrements associated with discontinuity were the same irrespective of whether discontinuities involved on- or off-team visits. The findings highlight the challenges of incorporating teams into primary care in ways that patients experience as value-added rather than disruptive to primary care relationships.;Section 2 clarifies whether visit continuity influences patients' experiences equally in various clinical situations. Physician-patient interaction quality and organizational access were more strongly influenced by visit continuity among respondents in early stages of a physician-patient relationship and with worse self-rated health. Visit continuity during early stages of a physician-patient relationship may ultimately increase the acceptability of approaches that leverage physician time.;Section 3 assesses which patient, physician, and organizational factors are related to voluntary physician switching among HIV-infected patients. Lower voluntary switching was predicted by patient trust, physician anti-retroviral knowledge, moderate (rather than low or high) HIV patient volume at a care site, and Ryan White Care Act funding. Patients with chronic illnesses may use several markers of specialization and technical quality to make decisions about their care.;Section 4 assesses the effect of care team composition on the quality of HIV care. In adjusted analyses, having a care team composed of three or more clinicians was associated with more consistent prescribing of Pneumocystis carinii (PCP) prophylaxis when medically-indicated. However, patients with multiple physicians generally reported worse care coordination and exhibited less appropriate use of emergency services. These findings highlight that team approaches offer a mix of advantages and disadvantages to patients.
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机译：越来越多的团队护理方法被认为对于改善复杂慢性病患者的质量以及一般初级保健实践至关重要。但是，许多研究表明，结构化护理有一些好处，因此个人提供者访问连续性是当务之急。本文旨在更好地理解各种条件如何影响团队绩效和向患者提供的优质护理。；第1节探讨了多学科初级护理团队对患者护理体验的影响。医师连续性越高，患者体验越好。病人对团队的评估是一个例外，当进行团队外访问时，评估会更好。对于其他措施，与不连续性相关的减量是相同的，无论不连续性涉及团队访问还是团队外访问。研究结果突显了将团队纳入患者提供增值而不破坏基础护理关系的方式纳入基础护理的挑战。；第2节阐明了探访连续性是否会在各种临床情况下平等地影响患者的体验。在医患关系的早期阶段以及自我评估的健康状况较差的情况下，受访者之间的访问连续性对医师与患者的互动质量和组织访问的影响更大。在医患关系早期阶段的访问连续性最终可能会提高利用医师时间的方法的可接受性。；第3节评估哪些患者，医师和组织因素与在HIV感染患者之间自愿转换医师有关。患者信任度，医师抗逆转录病毒知识，护理现场的中度（而不是低或高）HIV患者数量以及Ryan White Care Act资金预示了较低的自愿性转换。患有慢性病的患者可能会使用多个专业化和技术水平的指标来决定他们的护理。；第4节评估护理团队组成对HIV护理质量的影响。在调整后的分析中，如果有医学上的指示，则由三名或三名以上的临床医生组成的护理团队与卡氏肺囊虫（PCP）预防的更一致处方相关。但是，有多位医生的患者通常报告说他们的护理协调较差，对急救服务的使用较少。这些发现表明，团队合作方式为患者带来了各种优势和劣势。
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