论文部分内容阅读
目的探讨不同专业医生整合行为健康和初级医疗的互动方式,以及形成这种方式的影响因素。方法由多学科团队采用浸入式-结晶化途径,对纳入诊所进行案例比较研究。观察其业务情况,同时对诊所医生进行访谈,并分析其工作日志。纳入诊所均来自共同高级护理研究项目(advancing care together,包括科罗拉多州11家诊所)和整合劳动力研究项目(integration workforce study,包括美国8家诊所)。结果行为健康和初级医疗医生共采用了3种方式,分别为咨询、协调及合作(3Cs)。咨询,发生在需要向其他专业医生寻求建议、讨论治疗计划及证实患者需求时;协调,需由两名不同专业医生同时或先后明确同一患者的治疗目标,然后分别进行治疗;合作,发生在患者病情较为复杂或罕见时,由两名及以上专业医生进行实时互动,分析患者临床表现,阐述各自治疗看法,并共同制定治疗计划。3Cs的影响因素包括患者治疗计划制定时间、人事安排、是否使用简明治疗方法、团队成员距离及电子健康档案记录。结论行为健康和初级医疗医生,通过3Cs对患者进行协同治疗。建议相关机构营造有利于医生整合治疗的环境,以促进合作的进行;建议医疗人才培养机构加强对医生3Cs的培训,以促进该技巧在医疗实践中的应用。
Objective To explore the interaction between different professional doctors in integrating behavioral health with primary care and the influencing factors of the formation of this method. METHODS: A multi-disciplinary team used immersion-crystallisation approaches to compare case-by-case enrollment in clinics. Observe its business situation, interview clinic doctors at the same time, and analyze its working log. Admissions included advancing care together (including 11 Clinics in Colorado) and an integration workforce study (including 8 clinics in the United States). Results Behavioral health and primary care doctors used a total of three ways, namely consulting, coordination and cooperation (3Cs). Consultation takes place when it is necessary to seek advice from other medical practitioners, discuss the treatment plan and confirm the patient’s needs. Coordination requires two different professional doctors to define the same patient’s treatment goals at the same time or one after the other, and then treat them separately. Cooperation takes place in patients When the condition is complicated or rare, two or more professional doctors conduct real-time interaction to analyze the clinical manifestations of the patients, elaborate the respective treatment opinions, and jointly formulate the treatment plan. Factors influencing 3Cs include the timing of patient treatment planning, staffing, whether concise treatment is used, distance to team members, and electronic health records. Conclusions Behavioral health and primary care physicians, through 3Cs, co-treat patients. It is recommended that the relevant agencies should create an environment conducive to the doctor’s integration of treatment so as to promote cooperation. He suggested that medical personnel training institutions should strengthen the training of doctors on 3Cs so as to promote the application of the skills in medical practice.