■为了满足对胃肠病专科护理日益增长的需求和不断增加的等待时间,集中式访问和分类(CAT)系统,电话支持,我们实施了临床护理路径,以简化初级护理院低危胃肠道(GI)疾病的转诊和支持管理.这项研究旨在了解初级保健提供者(PCP)和GI专家对这些支持的看法,影响支持实施的因素,并从PCP和GI专家的角度确定实施支持的障碍和促进者。
■我们进行了一项混合方法研究,包括对PCP和GI专家的调查和访谈。在线调查和半结构化定性访谈于2022年7月至2022年9月进行。对所有访谈进行转录和编码以进行主题分析。调查数据采用SPSS25版进行分析。采用描述性统计来总结和描述收集的数据。推理统计用于识别数据集中的关联和关系。在95%置信水平下应用T检验和卡方检验。P值<0.05(双侧)被认为具有统计学意义。
■共有36个PCP对调查做出了回应。大多数受访者都是全职工作(73.5%,n=25),女性(73.5%,n=25)。总的来说,42%的人定期使用这些途径,48%(n=16)偶尔使用它们,很少(9.1%,n=3)说他们知道但没有使用途径。总的来说,PCP对CAT流程和初级保健途径的使用感到满意,认识到公平和公正获得专科护理的重要性。CAT中针对弱势人群和患者使用步入式诊所的特定过程被认为是一种局限性,鉴于在使用护理途径时无法轻松完成所需的测试和随访。在接受调查的112名GI专家中,28(25%)完成了它,男性(50.0%,n=14)和女性(39.2%,n=11),其余没有回应。大多数人参加CAT(73.9%,n=17),并由替代关系计划(ARP)(53.6%,n=15)。总的来说,GI对集中分诊和初级保健途径感到满意,减少转介的不必要的时间和资源支出。服务费和替代关系计划GI专家对CAT在改善卫生系统资源的获取和使用方面的有效性的看法存在统计学上的显着差异。
■总的来说,PCP和GI专家认为,利用CAT和初级保健途径可以提高转诊质量,减少资源支出,并提供公平公正的地理标志专业服务。通过改善途径意识来改善CAT过程可能会减少不必要的转诊。
UNASSIGNED: To address the increasing demands for gastroenterology specialty care and increasing wait times, centralized access and triage (CAT) systems, telephone support, and clinical care pathways were implemented to streamline referrals and support management of low-risk gastrointestinal (GI) conditions in the primary care medical home. This study aimed to understand primary care providers (PCPs) and GI specialists\' perceptions of these supports, factors that affect support implementation and identify barriers and facilitators for implementing supports from both PCP and GI specialists\' perspectives.
UNASSIGNED: We conducted a mixed method study including surveys and interviews with PCPs and GI specialists. Online surveys and semistructured qualitative interviews were conducted from July 2022 to September 2022. All interviews were transcribed and coded to perform a thematic analysis. Survey data were analyzed in SPSS version 25. Descriptive statistics were employed to summarize and describe the data collected. Inferential statistics were used to identify associations and relationships within the dataset. T-test and chi-square tests were applied at 95% confidence level, with a p value <0.05 (two-sided) considered statistically significant.
UNASSIGNED: A total of 36 PCPs responded to the survey. Most respondents were working full-time (73.5%, n = 25) and were female (73.5%, n = 25). Overall, 42% used the pathways regularly, 48% (n = 16) used them occasionally, and very few (9.1%, n = 3) said they were aware but had not used pathways. Overall, PCPs were satisfied with CAT processes and the use of primary care pathways, recognizing the importance of fair and equitable access to specialty care. Specific processes in CAT for vulnerable populations and patients using walk-in clinics were recognized as a limitation, given the lack of ease in completing the required testing and follow-up needed when utilizing the care pathway. Of the 112 GI specialists who received the survey, 28 (25%) completed it, with males (50.0%, n = 14) and females (39.2%, n = 11), remainder no response. Most participate in CAT (73.9%, n = 17) and were remunerated by an alternative relationship plan (ARP) (53.6%, n = 15). Overall, GIs were satisfied with central triaging and primary care pathways, reducing unnecessary time and resource expenditure for referrals. There were statistically significant differences in perceptions among fee for service and alternative relationship plan GI specialists regarding the effectiveness of CAT in improving access and use of health system resources.
UNASSIGNED: Overall, PCPs and GI specialists believe utilizing CAT and primary care pathways improves referral quality, reduces resource expenditure, and provides fair and equitable access to GI specialty services. Improvement in CAT processes with improved pathway awareness may reduce unnecessary referrals.