中国全科医学2024，Vol.27Issue(13) ：1608-1615.DOI:10.12114/j.issn.1007-9572.2023.0334

基于扎根理论的家医服务背景下轻度认知障碍人群慢病管理执行力的影响因素研究

A Study on the Factors Influencing Performance of Chronic Disease Management among Population with Mild Cognitive Impairment in the Context of Family Doctor Service Based on Grounded Theory

翟佳燚 陆媛 陶琼英 黄武全 刘亚林 于德华
中国全科医学2024，Vol.27Issue(13) ：1608-1615.DOI:10.12114/j.issn.1007-9572.2023.0334
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基于扎根理论的家医服务背景下轻度认知障碍人群慢病管理执行力的影响因素研究

A Study on the Factors Influencing Performance of Chronic Disease Management among Population with Mild Cognitive Impairment in the Context of Family Doctor Service Based on Grounded Theory

翟佳燚 1陆媛 2陶琼英 3黄武全 3刘亚林 3于德华2
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作者信息

  • 1. 200090 上海市,同济大学附属杨浦医院全科医学科;201899 上海市嘉定区嘉定镇街道社区卫生服务中心;200090 上海市,同济大学医学院全科医学系
  • 2. 200090 上海市,同济大学附属杨浦医院全科医学科;200090 上海市,同济大学医学院全科医学系;200090 上海市全科医学与社区卫生发展研究中心
  • 3. 201899 上海市嘉定区嘉定镇街道社区卫生服务中心
  • 折叠

摘要

背景 对轻度认知障碍人群开展慢病管理能够减轻疾病对社会、家庭、个人的负担,家庭医生团队作为我国目前慢病管理的主力军,其执行力是服务质量的关键.目的 探索家庭医生团队为轻度认知障碍人群提供慢病管理服务执行力的影响因素.方法 2021 年 7 月,采用目的抽样法选取上海市 4 个区 8 家社区卫生服务中心的 28 名医务人员开展半结构访谈,访谈结束后对访谈资料进行编码和分析.结果 经过三级编码,本次研究梳理概念114条、范畴49个、主范畴8个,总结出家庭医生团队为轻度认知障碍人群提供慢病管理执行力的影响因素包括服务组织方(政府)、服务供方(医方)、服务需方(患方)、任务执行 4 个核心范畴.理论框架主要分为 5 个脉络,一是组织方驱动供需双方脉络;二是供方主动执行脉络;三是需方配合执行脉络;四是供需双方交互影响脉络;五是任务执行循环改进脉络.结论 家医团队对轻度认知障人群慢病管理的执行力受多种因素影响,执行过程和结果是检验执行力的关键,服务组织方的驱动作用、服务供方执行功能、服务需方配合执行是执行过程和结果的前提,但任务执行过程与结果的反馈作用能够改进服务质量,最终形成组织方驱动-供方执行与需方配合-任务执行反馈的循环优化机制.

Abstract

Background Management of mild cognitive impairment(MCI)can reduce the burden of disease on society,families and individuals.The performance of family doctor team is the key to the quality of service,which acts as the main force of chronic disease management in China.Objective To explore the factors influencing the performance of family doctor teams in providing chronic disease management service for patients with MCI.Methods In July 2021,a total of 28 medical workers from 8 community health service centers in 4 districts of Shanghai were selected by purposive sampling method to conduct semi-structured interviews,the interview data were coded and analyzed after the interviews.Results After three levels of coding,114 concepts,49 categories and 8 main categories were sorted out,4 core categories of factors influencing performance were concluded of service organizer(government),service provider(doctor),service demander(patient)and task implementation.The theoretical framework was organized into five main processes,including organizers driving both provider and demander,provider taking the initiative to implement,demander cooperating with implementation,interaction between provider and demander,task execution cycle improvement.Conclusion Although performance of family doctor teams in providing chronic disease management service for patients with MCI is affected by many factors,the process and results are the key to test performance.The driving role of the organizer,execution function of the provider and cooperation of demander are the premise for execution process and result.However,the feedback effect of task execution can improve the quality of service,and eventually form a circular optimization mechanism from organizer drive,to provider execution and demander cooperation,to task execution feedback.

关键词

认知功能障碍/全科医学/慢性病/慢病管理/执行力/扎根理论/影响因素分析

Key words

Cognitive dysfunction/General practice/Chronic disease/Chronic disease management/Performance/Grounded theory/Root cause analysis

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基金项目

上海市卫生健康委员会卫生行业临床研究专项立项项目(20194Y0159)

上海市社区卫生协会2021年社区科研项目(SWX21M06)

上海市嘉定区卫生健康委员会政策研究课题(2021JDHP11)

2020年嘉定区卫生健康委科研立项重点项目(2020-ZD-07)

出版年

2024
中国全科医学
中国医院协会

中国全科医学

CSTPCD北大核心
影响因子：2.04
ISSN：1007-9572
参考文献量32
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