背景:采用高价值,成本意识护理(HVCCC)原则在医学教育中的重要性日益增加,这是由于全球医疗保健成本飙升以及人们认识到有效的护理可以提高患者的治疗效果和控制成本。了解当前的机遇和挑战,医生面临的关于医疗保健系统HVCCC是至关重要的,以适应医生的需求教育。因此,本研究旨在探索医学生,初级医生,和高级医生在HVCCC方面的经验,并寻求高级医生关于教育如何在临床环境中培养HVCCC的观点。
方法:使用混合方法设计,我们的研究涉及使用马斯特里赫特HVCCC态度问卷(MHAQ)的横断面调查,一部分顾问参与半结构化面试。描述性分析提供了对分类变量和非分类变量的见解,在不同角色的差异(学生,实习生,初级医生,高级医生)通过Kruskal-Wallis测试,辅以使用Mann-WhitneyU检验的两组分析。我们使用Spearman的rho将经验与MHAQ分数相关联,测试了MHAQ与Cronbachα的内部一致性,并对定性数据进行了专题分析。
结果:我们收到了416份调查回复,12名资深医生参加了半结构化访谈。总的来说,所有群体对HVCCC表现出适度的积极态度,更有经验的医生表现出更有利的观点,特别是将成本融入日常实践。在采访中,参与者同意在本科教学中灌输HVCCC值并在研究生培训中补充正式课程的重要性。这个,加上在职获得的实践知识,被视为培训医生的有益策略。
结论:该样本的医学生和医院医生对HVCCC普遍表现出积极的态度,高价值护理服务,以及医疗保健成本的整合,建议学生和医生接受未来的HVCCC培训。经验是HVCCC的关键因素,因此,早期接触这些概念可能会增强现有医疗保健预算中的实践。
BACKGROUND: Adopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors\' needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors\' experiences with HVCCC, and to seek senior doctors\' viewpoints on how education can foster HVCCC in clinical environments.
METHODS: Using a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman\'s rho, tested MHAQ\'s internal consistency with Cronbach\'s alpha, and employed thematic analysis for the qualitative data.
RESULTS: We received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors.
CONCLUSIONS: This sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets.