背景:纽约市约有241,000人患有乙型肝炎。在那些患有乙型肝炎的人中,由于免疫反应的变化,孕妇尤其面临病毒载量升高的风险,需要与医疗保健迅速联系。纽约市卫生与精神卫生署的病毒性肝炎计划实施了基于电话的患者导航干预,为产后期的乙型肝炎患者将其与乙型肝炎护理联系起来。
方法:在干预期间,病人导航员打电话给参与者询问他们过去接受护理的经历,可用的支持,和护理障碍,并与他们一起制定与参与者联系到乙型肝炎护理的计划。在初始评估和后续互动期间收集的信息被记录为案例注释。在这项定性研究中,研究人员进行了102套病例笔记的主题分析,以检查促进者和障碍,以获得乙肝护理干预参与者之间,所有这些人都是外国出生的,对接受乙型肝炎患者导航服务感兴趣。
结果:定性分析说明了患者导航员支持获得乙型肝炎治疗的各种方式。研究结果表明,通过首选提供者接受护理是获得护理的核心因素,即使存在重大障碍,例如失去健康保险和在预约期间缺乏托儿服务。家庭成员对乙型肝炎筛查的期望,疫苗接种和常规临床随访也被认为是促进参与者自身护理的因素.
结论:这项研究表明,尽管在个人和系统层面存在许多障碍,该患者导航干预与确定的促进者一起支持人们获得乙型肝炎治疗.其他患者导航计划可以结合来自此分析的经验教训,以支持人们连接到首选提供商。
Approximately 241,000 people are living with hepatitis B in New York City. Among those living with hepatitis B, pregnant people are particularly at risk for elevated viral load due to changes in immune response and require prompt linkage to health care. The New York City Department of Health and Mental Hygiene\'s Viral Hepatitis Program implemented a telephone-based patient navigation intervention for people living with hepatitis B in the postpartum period to connect them with hepatitis B care.
During the intervention, patient navigators called participants to inquire about their past experience with receiving care, available supports, and barriers to care, and worked with them to develop a plan with participants for linkage to hepatitis B care. The information collected during initial assessments and follow-up interactions were recorded as
case notes. In this qualitative study, researchers conducted a thematic analysis of 102 sets of
case notes to examine facilitators and barriers to accessing hepatitis B care among the intervention participants, all of whom were foreign-born and interested in receiving hepatitis B patient navigation services.
The qualitative analysis illustrated the various ways in which patient navigators supported access to hepatitis B care. Findings suggest that receiving care through a preferred provider was a central factor in accessing care, even in the presence of significant barriers such as loss of health insurance and lack of childcare during appointments. Expectations among family members about hepatitis B screening, vaccination and routine clinical follow up were also identified as a facilitator that contributed to participants\' own care.
This study suggests that while there are numerous barriers at the personal and systemic levels, this patient navigation intervention along with the identified facilitators supported people in accessing hepatitis B care. Other patient navigation initiatives can incorporate the lessons from this analysis to support people in connecting to a preferred provider.