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首页> 外文期刊>Journal of health services research & policy >Drivers of preventable high health care utilization: a qualitative study of patient, physician and health system leader perspectives
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Drivers of preventable high health care utilization: a qualitative study of patient, physician and health system leader perspectives

机译：可预防的高医疗利用的驱动因素：患者，医师和卫生系统领导者的定性研究

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Objectives A small percentage of patients account for the bulk of population health care utilization and costs in many countries including the United States (US). In the US, 5% of the population has high health care utilization accounting for nearly 50% of health care costs. A subset of this utilization is deemed preventable, and thus potentially cost saving to patients as well as to the health care system. This study sought to identify drivers of preventable utilization from the perspectives of three stakeholder groups in the US: health system leaders; high-need, high-cost (HNHC) patients or their primary caregivers; and physicians. Methods We performed a qualitative study using interviews of health system leaders and focus groups of HNHC patients, caregivers and physicians. We used a mixed inductive deductive approach to analyse transcripts and identify themes. Results We identified three key drivers of preventable high health care utilization: (1) unmet behavioural health needs, (2) socio-economic determinants of health and (3) challenges associated with accessing health care delivery systems. Conclusions To be potentially more effective, interventions to reduce preventable high health care utilization should incorporate the perspectives of patients, health system leaders and physicians. Particularly important to stakeholders is increased access to mental-health resources, support for patients with low socio-economic resources and systemic changes that reduce wait times for primary care visits and allow providers more time during patient visits.
机译：目标在包括美国在内的许多国家，一小部分患者占人口卫生保健利用率和成本的大部分。在美国，5%的人口拥有高医疗利用率，占医疗成本的近50%。这种利用的一部分被认为是可以预防的，因此可能会为患者和医疗系统节省成本。这项研究试图从美国三个利益相关者群体的角度确定可预防利用的驱动因素：卫生系统领导者；高需求、高成本（HNHC）患者或其主要照顾者；还有医生。方法通过对卫生系统领导和HNHC患者、护理人员和医生的焦点小组进行访谈，进行定性研究。我们使用了一种混合归纳演绎的方法来分析成绩单并确定主题。结果我们确定了可预防的高医疗利用率的三个关键驱动因素：（1）未满足的行为健康需求，（2）健康的社会经济决定因素，（3）与获得医疗服务提供系统相关的挑战。结论为了可能更有效，减少可预防的高医疗利用率的干预措施应纳入患者、卫生系统领导人和医生的观点。对利益相关者来说，尤其重要的是增加获得精神卫生资源的机会，为社会经济资源较低的患者提供支持，以及减少初级保健就诊等待时间、让提供者在患者就诊期间有更多时间的系统性变化。

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