Abstract：
Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a \"digital-first\" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants\' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients\' and providers\' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.
摘要：
关系,建立在信任的基础上，知识,关于,和忠诚,已被证明是提供医疗保健的基础。患者和提供者之间的牢固关系与更富有同情心的护理服务有关，更好的患者体验和结果，在初级保健中可能特别重要。自COVID-19爆发以来，数字技术的迅速采用导致医疗保健系统认真考虑“数字优先”的初级保健提供模式。关于这种转变将对治疗关系产生什么影响的问题仍然存在。使用快速人种学方法，本研究探讨了患者和提供者对治疗关系和数字健康技术的理解如何影响具有复杂护理需求的患者与其护理提供者之间的关系建立或维护。多伦多的三个以团队为基础的初级保健点，安大略省,加拿大被纳入研究。在这三个地点，有9名患有慢性健康状况的患者，1名护理人员,和10名医疗保健提供者(包括家庭医生，家庭医学居民，社会工作者,和执业护士)参与。对所有参与者进行了访谈，并进行了8次虚拟临床观察（电话和视频访问）。以社会表征理论为镜头，分析显示，参与者的治疗关系和数字技术的结构是由他们的身份决定的，经验,和期望。让参与者看到技术有助于治疗关系，需要在参与者如何看待技术在护理和生活中的作用之间保持一致，以及他们如何认识（或构建）良好的治疗关系。这项探索性工作表明，有必要考虑患者和提供者对技术的看法如何决定是否可以利用数字技术来满足患者的需求，同时保持，或建筑，强大的治疗关系。
