背景:当21个瑞典县议会决定合作创建基于知识的管理的国家系统时,患者参与是强制性的.患者和近亲代表(PR)与医疗保健专业人员(HPR)共同制作了以人为本和有凝聚力的临床路径。在国家一级,关于医疗保健联合生产的研究很少。这项研究的目的是在瑞典全国医疗保健系统内共同生产基于知识的管理的临床路径时,从PR和HPR的角度探索患者参与的经验。
方法:进行了定性研究。在2022年8月至2023年1月之间,使用半结构化访谈指南对9个PR和8个HPR的战略样本进行了单独访谈。我们使用归纳内容分析来分析数据。
结果:确定了三个主要类别:(1)找到适当的患者代表性;(2)促进患者观点的工作方法;(3)患者观点在临床路径中的影响。
结论:该研究证明了患者和亲属参与国家层面临床路径构建的重要性。这些结果为在国家层面上进一步研究患者参与提供了一个平台,并增加了关于患者在这一层面上的参与是否以及如何影响临床路径在微观层面上的实施的研究。以及在中观层面提供的支持。该研究有助于研究患者参与和共同生产的文献越来越多。
背景:厄勒布罗县ID276,940。咨询意见是从瑞典伦理审查局(2021-05899-01)获得的。
与患者和近亲代表共同制作指南和临床路径在国际医疗保健领域的不同层面日益受到重视。然而,关于患者参与国家层面的经验,几乎没有文献记载和探索。当瑞典启动基于知识的国家医疗保健管理系统时,患者参与是强制性的。医疗保健的知识管理是与创建,分享,使用和管理组织的知识和信息。瑞典的所有21个地区和政府都支持这一合作系统,该系统由具有患者代表的多专业国家工作组组成。这些小组开发临床路径,旨在加强协调,平等和有效的医疗保健。以人为本的临床路径描述了评估,诊断,对条件的规划和评估,例如对于髋部骨折的患者,或者充血性心力衰竭.该研究侧重于患者参与国家工作组的经验。我们采访了来自11个不同小组的9名患者代表和8名医疗保健专业代表。我们的研究结果表明,确定和找到适当的患者代表性的重要性,具有促进患者观点和影响临床路径的患者观点的工作方法。这项关于患者参与国家一级临床路径建设的研究有助于越来越多的关于共同生产知识支持的文献。研究结果强调了在国家一级继续发展有意义的患者参与的重要学习。这也引起了人们对联合生产的国家方法如何影响使用准则的地方级别的好奇心。
BACKGROUND: When the 21 Swedish county councils decided to collaborate in the creation of a national system for knowledge-based management, patient participation was mandatory. Patient and next-of-kin representatives (PR) co-produced person-centred and cohesive clinical pathways together with healthcare professionals (HPR). Research on co-production in healthcare at the national level is scarce. The aim of this
study is to explore experiences of patient participation from the perspectives of both PRs and HPRs when co-producing clinical pathways within the Swedish nationwide healthcare system for knowledge-based management.
METHODS: A qualitative
study was conducted. A strategic sample of nine PRs and eight HPRs were interviewed individually between August 2022 and January 2023 using a semi-structured interview guide. We analysed data using an inductive content analysis.
RESULTS: Three main categories were identified: (1) Finding appropriate patient representativeness; (2) Working methods that facilitate a patient perspective; and (3) Influence of the patient perspective in the clinical pathways.
CONCLUSIONS: The
study demonstrates the importance of patient and next-of-kin participation in the construction of clinical pathways at the national level. The results provide a platform for further research on patient participation on the national level and add to studies on if and how patient participation on this level has an impact on how the clinical pathways are put into practice at the micro level, and the support provided at the meso level. The
study contributes to the growing body of literature studying patient participation and co-production.
BACKGROUND: Region Örebro County ID 276,940. An advisory opinion was obtained from the Swedish Ethical Review Authority (2021-05899-01).
Co-production of guidelines and clinical pathways with patients and next-of-kin representatives is increasingly emphasised at different levels in healthcare internationally. However, little has been documented and explored regarding experiences of patient participation on a national level. Patient participation was mandatory when a national system for knowledge-based management of healthcare was launched in Sweden. Knowledge management of healthcare is the collection of methods relating to creating, sharing, using and managing the knowledge and information of an organization. All 21 of Sweden’s regions and the government have supported this collaborative system consisting of multi-professional national working groups with patient representatives. The groups develop clinical pathways aiming to enhance a coordinated, equal and effective healthcare. The person-centred clinical pathways describe assessment, diagnosis, planning and evaluation for a condition, for example for patients with a hip fracture, or congestive heart failure. The
study focuses on experiences of patient participation in the national working groups. We interviewed nine patient representatives and eight healthcare professional representatives from eleven different groups. Our findings show the importance of identifying and finding appropriate patient representativeness, having working methods that facilitate a patient perspective and the patient perspective influencing the clinical pathways. This study on patient participation in the construction of clinical pathways at the national level contributes to the growing body of literature on co-production of knowledge support. The findings highlight important learning for the continued development of meaningful patient participation on the national level. It also raises curiosity on how the national approach with co-production influences local levels where the guidelines are used.