Abstract：
BACKGROUND: Liver disease is common, but not part of routine chronic disease management in primary care.
OBJECTIVE: The aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care.
METHODS: Semi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis.
RESULTS: Three themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work.
CONCLUSIONS: The inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.
OBJECTIVE: The aim of this study was to explore the challenges of implementing pathways of care for liver disease within existing highly protocolised structures in primary care.
METHODS: Semi-structured interviews with 20 health professionals working in primary care. Interviews were informed by normalisation process theory (NPT) and boundary theory. Data were subject to thematic analysis.
RESULTS: Three themes were identified relating to chronic disease work; definitions; need and worth, and roles. Participants identified that understanding and value of roles within chronic disease management were pre-defined by targets imposed on them as part of national incentives schemes. Structural boundaries constrained professional autonomy and the potential to influence this area of primary care management, including taking on new work.
CONCLUSIONS: The inability to influence care decisions blurs occupational boundaries and goes to the core of what it means to be a professional. Unless liver disease sits within this target-based system, it is unlikely to become part of routine work in primary care.
摘要：
背景：肝病很常见，但不是初级保健常规慢性病管理的一部分。
目的：本研究的目的是探索在初级保健中现有的高度标准化结构中实施肝病护理途径的挑战。
方法：对20名初级保健专业人员进行半结构化访谈。访谈是由正常化过程理论（NPT）和边界理论提供的。数据进行专题分析。
结果：确定了与慢性病工作有关的三个主题；定义；需求和价值，和角色。与会者认为，慢性病管理中角色的理解和价值是由作为国家激励计划的一部分强加给他们的目标预先定义的。结构界限限制了专业自主权和影响初级保健管理这一领域的潜力，包括承担新工作。
结论：无法影响护理决策模糊了职业界限，并成为专业人士的核心。除非肝病位于这个基于目标的系统中，它不太可能成为初级保健常规工作的一部分。
目的：本研究的目的是探索在初级保健中现有的高度标准化结构中实施肝病护理途径的挑战。
方法：对20名初级保健专业人员进行半结构化访谈。访谈是由正常化过程理论（NPT）和边界理论提供的。数据进行专题分析。
结果：确定了与慢性病工作有关的三个主题；定义；需求和价值，和角色。与会者认为，慢性病管理中角色的理解和价值是由作为国家激励计划的一部分强加给他们的目标预先定义的。结构界限限制了专业自主权和影响初级保健管理这一领域的潜力，包括承担新工作。
结论：无法影响护理决策模糊了职业界限，并成为专业人士的核心。除非肝病位于这个基于目标的系统中，它不太可能成为初级保健常规工作的一部分。
