■一般实践面临着挑战,例如患者需求的增加以及招募和留住全科医生的困难。人们提倡更多地使用数字技术,以减轻其中的一些挑战并改善患者的访问。这包括数字第一初级保健,当患者与初级保健的第一次接触是通过数字途径,通过笔记本电脑或智能手机。自COVID-19以来,数字第一初级保健的使用已经加快。几乎没有证据表明工作人员在更复杂的患者中使用数字第一初级保健的经验,比如那些有多个长期条件的人。
■从医疗保健专业人员和利益相关者的角度了解具有数字第一初级保健多种长期条件的人的经验。
■这是一个定性评估,由四个不同的工作包组成:工作包1:将研究定位在更广泛的背景下,从事文学,并与患者共同设计研究方法和研究问题。工作包2:采访跨一般实践和关键专家主题利益相关者的卫生专业人员,包括学者和政策制定者。工作包3:数据分析和主题生成,并与患者测试结果。工作包4:综合,报告和传播。
■该研究于2021年1月开始,在2022年1月至8月期间,共对14名卫生专业人员和15名利益相关者进行了28次访谈。从卫生专业人员的角度来看,数字第一初级保健方法可以使患者比传统方法更快地与临床医生交谈。患有多种长期疾病的人可以在家中提交医疗保健读数,尽管卫生专业人员认为,患者可能会在导航数字系统时遇到困难,而不是为了捕捉与多种疾病生活相关的细微差别。临床医生表示愿意与患者面对面,特别是那些有多个长期条件的人,识别关于病人健康的非语言线索。数字第一初级保健方法为临床医生提供了与患有多种长期疾病的患者的护理人员接触的机会。然而,在获得同意和保密方面存在担忧。利益相关者之间仍在就数字第一初级保健对员工工作量的影响的性质和程度进行辩论。
■在收集数据时,一般实践在提供护理和应对COVID-19大流行方面面临相当大的压力。虽然这项研究最初打算包括对患有多种长期疾病的患者及其护理人员的访谈,参与研究的一般实践均不愿意和/或能够在可用的时间内招募患者和护理人员.
■快速实施数字化第一初级保健,在巨大压力下,意味着几乎没有时间考虑对患者的影响,包括那些有多个长期条件的人。对护理连续性的影响在很大程度上取决于手术如何实施其方法。工作人员和利益相关者认为,数字第一初级保健,作为获得初级保健的额外途径,对于患有多种长期疾病的患者可能有用,但不会以面对面咨询为代价。
■未来研究获得患者和护理人员对数字优先方法的看法,了解对护理人员的影响以及如何为患有更复杂疾病的患者设计方法,是必不可少的。
■该奖项由美国国家卫生与护理研究所(NIHR)卫生与社会护理提供研究计划(NIHR奖参考:16/138/31)资助,并在《健康与社会护理提供研究》中全文发表。12号21.有关更多奖项信息,请参阅NIHR资助和奖励网站。
面对越来越大的压力,医疗保健专业人员希望提供最好的初级保健,以及改善患者获得护理的机会。数字第一初级保健是对这种情况的一种回应,当患者通过数字途径与初级保健进行首次接触时,通过笔记本电脑或智能手机。在线系统允许患者向他们的实践提供关于他们的症状或需求的信息,并请求健康专业人员的响应。我们的研究旨在了解数字第一初级保健如何为医疗保健专业人员提供护理,以增加患有多种长期疾病的患者及其护理人员的数量。首先,我们检查了相对有限的现有调查结果,然后采访了医疗保健专业人员和初级保健中数字方法的主要利益相关者(例如,来自政策组织,大学和国家卫生局)。当我们试图直接与病人和护理人员交谈时,不幸的是,一般实践中的压力意味着我们无法做到这一点。然而,本研究是与患者共同设计的.医疗保健专业人员和利益相关者认为,与其他患者相比,患有多种长期疾病的患者在使用数字第一初级保健时面临着额外的挑战。例如,他们报告说,在浏览在线表格时遇到困难,无法与熟悉他们的全科医生交谈。医疗保健专业人员和利益相关者对数字第一初级保健可以在多大程度上帮助普通实践中的员工并加强护理,有不同的看法。对于一些临床医生来说,工作量更容易管理,一些简单的任务(例如病假笔记)可以很快完成。这可以减轻工作人员的压力,并意味着每天可以看到更多的患者。其他人认为数字系统有缺点。这对于患有多种长期疾病的患者可能很重要;例如,当数字表格可能无法完全告知全科医生问题的确切性质时,可能需要进一步的后续预约。卫生专业人员报告说,患有多种长期疾病的患者的护理人员通常喜欢新系统,因为它们有助于改善与全科医生的联系。该摘要由BRACE患者和公众参与小组的成员共同撰写。
UNASSIGNED: General practices are facing challenges such as rising patient demand and difficulties recruiting and retaining general practitioners. Greater use of digital technology has been advocated as a way of mitigating some of these challenges and improving patient access. This includes Digital First Primary Care, when a patient\'s first contact with primary care is through a digital route, either through a laptop or smartphone. The use of Digital First Primary Care has been expedited since COVID-19. There is little evidence of staff experiences of using Digital First Primary Care with more complex patients, such as those with multiple long-term conditions.
UNASSIGNED: To understand the experiences of those with multiple long-term conditions of Digital First Primary Care from the perspectives of healthcare professionals and stakeholders.
UNASSIGNED: This was a qualitative evaluation, comprised of four distinct work packages: Work package 1: Locating the study within the wider context, engaging with literature, and co-designing the study approach and research questions with patients. Work package 2: Interviews with health professionals working across general practice and key expert topic stakeholders, including academics and policy-makers. Work package 3: Analysis of data and generation of themes, and testing findings with patients. Work package 4: Synthesis, reporting and dissemination.
UNASSIGNED: The study commenced in January 2021 and in total 28 interviews were conducted with 14 health professionals and 15 stakeholders between January and August 2022. From the perspective of health professionals, Digital First Primary Care approaches could enable patients to speak with a clinician more quickly than traditional approaches. Those with multiple long-term conditions could submit healthcare readings from home, though health professionals felt patients may struggle navigating digital systems not designed to capture the nuances associated with living with multiple conditions. Clinicians expressed preferences for seeing patients face-to-face, particularly those with multiple long-term conditions, to identify non-verbal cues about a patient\'s health. Digital First Primary Care approaches provided an opportunity for clinicians to engage with the carers of patients living with multiple long-term conditions, yet there were concerns around obtaining consent and confidentiality. There remain debates among stakeholders about the nature and extent to which Digital First Primary Care impacts on staff workload.
UNASSIGNED: At the time of data collection, general practices were facing considerable pressure to deliver care and respond to the COVID-19 pandemic. While it was originally intended that the study would include interviews with patients with multiple long-term conditions and their carers, none of the general practices that took part in the study were willing and/or able to recruit patients and carers in the time available.
UNASSIGNED: The rapid implementation of Digital First Primary Care, at a time of immense pressures, meant there has been little time for considering the impact on patients, including those with multiple long-term conditions. The impacts on care continuity depended largely on how surgeries implemented their approaches. Staff and stakeholders felt that Digital First Primary Care, as an additional route for accessing primary care, could be useful for patients with multiple long-term conditions but not at the expense of face-to-face consultations.
UNASSIGNED: Future research obtaining patient and carer views of digital-first approaches, understanding the impacts on carers and how approaches are designed with patients with more complex conditions in mind, is essential.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/138/31) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 21. See the NIHR Funding and Awards website for further award information.
Healthcare professionals want to provide the best primary care in the face of increasing pressures, as well as improve access to care for patients. Digital First Primary Care is one response to this situation, when a patients’ first contact with primary care is through a digital route, either through a laptop or smartphone. Online systems allow the patient to provide information to their practice about their symptoms or needs and request a response from a health professional. Our study aimed to understand how Digital First Primary Care works for healthcare professionals providing care to increasing numbers of patients with multiple long-term conditions and their carers. Firstly, we examined the relatively limited existing findings and then interviewed healthcare professionals and key stakeholders experienced in digital approaches within primary care (e.g. from policy organisations, universities and the National Health Service). While we attempted to speak to patients and carers directly, unfortunately the pressures in general practice meant we were unable to do so. However, the study was co-designed with patients. Healthcare professionals and stakeholders felt that patients with multiple long-term conditions faced additional challenges with the use of Digital First Primary Care compared to other patients. For example, they reported difficulties navigating online forms and not being able to speak with a general practitioner who knew them well. There were differing views from healthcare professionals and stakeholders about how far Digital First Primary Care could help staff in general practice and enhance care. For some clinicians, the workload was easier to manage and some simple tasks (e.g. sick notes) could be completed quickly. This could reduce stress for staff and mean more patients could be seen per day. Others felt that the digital system had shortcomings. This could be important for patients with multiple long-term conditions; for example, when a digital form may not fully inform the general practitioner as to the exact nature of the problem, potentially requiring a further follow-up appointment. Health professionals reported that carers of patients with multiple long-term conditions generally liked the new systems as they helped to improve contact with general practice staff. The summary was co-authored by members of the BRACE Patient and Public Involvement group.