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首页> 外文期刊>BMC Family Practice >What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives
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What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives

机译：在澳大利亚的全科医生中，慢性病患者在获得护理时有什么要紧？对患者，护理人员和提供者观点的定性研究

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Research underpinning the patient experience of people with chronic conditions in Australian general practice is not well developed. We aimed to ascertain the perspectives of key stakeholders on aspects of patient experience, more specifically with regards to accessing general practice in Australia. Using a qualitative design, semi-structured interviews were conducted by telephone and face-to-face with people living with one or more chronic conditions, informal carers, and primary care providers between October 2016 and October 2017. Participants were recruited and selected from three demographically representative primary health networks across Sydney, Australia. Interview transcripts and researcher’s reflective fieldnotes were coded and analyzed for key themes of access. Analysis and interpretation of data were guided by Levesque’s model of access, a conceptual framework to evaluate access broadly and from corresponding patient- and provider-side dimensions. A total of 40 interviews were included in the analysis. Most participants had attended their general practices for 10?years or more and had regular primary care providers. People with chronic conditions reported access barriers predominantly in their ability to reach services, which were related to illness-related disabilities (limited mobility, chronic pain, fatigue, frailty) and limitations in the availability and accommodation of health services to address patient preferences (unavailability of after-hours services, lack of alternative modes of service delivery). While cost was not a major barrier, we found a lack of clarity in the factors that determined providers’ decisions to waive or reduce costs for some patients and not others. People managing chronic conditions with a long-term primary care provider experienced access barriers in general practice, particularly in their ability to physically reach care and to do so on a timely basis. This study has important policy and practice implications, as it highlights patients’ experiences of accessing care and possible areas for improvement to appropriately respond to these experiences. Themes identified may be useful in the design of a patient experience survey tool specific to this population. While it incorporates perspectives from patients, carers and providers, this study could be further strengthened by including perspectives from culturally and linguistically underrepresented patient groups and more carers.
机译：在澳大利亚的一般实践中，对患有慢性病患者的患者经历进行支持的研究尚不完善。我们旨在确定主要利益相关者对患者体验方面的观点，尤其是在澳大利亚获取全科医学方面的观点。使用定性设计，在2016年10月至2017年10月之间，通过电话和面对一个或多个慢性病患者，非正式护理人员和初级保健提供者进行了半结构式访谈。从三名参与者中招募并选出了参与者澳大利亚悉尼全国人口统计学上具有代表性的初级卫生网络。采访笔录和研究人员的反思性现场笔记均经过编码和分析，以了解访问的关键主题。数据的分析和解释以Levesque的访问模型为指导，Levesque的访问模型是一个概念框架，可广泛评估访问，并从相应的患者和提供者方面进行评估。分析中总共进行了40次采访。大多数参与者参加了10年或更长时间的常规治疗，并有定期的初级保健提供者。慢性病患者报告获得服务的障碍主要是获得服务的障碍，这与疾病相关的残疾（行动不便，慢性疼痛，疲劳，虚弱）以及为满足患者喜好而提供的医疗服务和住宿受到限制（无法使用）有关。营业时间以外的服务，缺乏其他提供服务的方式）。尽管费用不是主要障碍，但我们发现决定提供者决定放弃或减少某些患者而非其他患者费用的因素缺乏明确性。与长期的初级保健提供者一起管理慢性病的人们在一般实践中会遇到障碍，尤其是他们在身体上能够获得护理并及时做到的能力。这项研究具有重要的政策和实践意义，因为它着重强调了患者在获得护理方面的经验以及可能需要改进的领域，以对这些经验做出适当的反应。确定的主题可能在设计针对该人群的患者体验调查工具时很有用。尽管纳入了患者，护理人员和提供者的观点，但可以通过纳入文化和语言上代表性不足的患者群体和更多护理人员的观点来进一步加强本研究。

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