出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : The subject of this study was to collect patient opinions related to coordinated health care organization before pilot implementation phase of a coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund. The research was intended to verify hypotheses regarding patients’ satisfaction, the role of coordinator and patients’ health education, recruitment to health checkups, access to specialists and individual disease management. Methodology : The study employed qualitative (focus group interviews – FGIs – 24 adult patients in 3 subgroups, 17 questions) and quantitative (computer-assisted internet interviews – CAWI – representative sample of 1000 patients, 18 questions) techniques. CAWI questions derived from FGI discussions. To be enrolled, patients had to use public primary or specialist health care at least twice in the last two years. The study was carried out in April - May 2017. Results : FGIs revealed that the concept of regular health checkups performed among non-symptomatic patients was accepted, but the proposed exclusion of patients older than 65 years of age was contested. The idea of disease management met approval. The main benefit pointed out was the fast diagnosis followed by coordinated treatment in PHC with specialists’ support. 76,2% of patients in CAWI agreed for sharing their medical data to medical staff involved, if this improves the treatment process. 84.3% of patients appreciated adding their health information to patient accounts, 4.9% were against and 1.3% definitely excluded that. The risk of being treated by incompetent specialist was raised during FGIs and confirmed during CAWI, so patients expected to be allowed to change doctor in such a case. However, patients would be ready to give up their own choice of a specialist, if the waiting time for the diagnosis is reduced to about 2 weeks. The role of health care coordinator was appreciated. Discussion and conclusions : Respondents declared that coordinated care concept meets their expectations. They were interested in participation in health checkups and disease management programs, perceived as a solution to avoid queuing for specialists’ visits and to shorten the time needed to establish the diagnosis. The need for greater engagement in the treatment process did not deter the proposed solutions. Patients also positively evaluated the role of a health care coordinator. 62.2% of patients were ready to change the healthcare institution, if the existing one does not offer the coordinated care. Lessons learned : The common belief among patients is that the implementation of coordination in Poland will result in positive changes in the organization of public health care. Thus, changes planned in this sector might be welcomed by most of patients. Limitations : Opinions gathered could not be verified by patients in the real-life setting, but a high degree of trust was granted by them. Future studies : Further studies focused on patients’ satisfaction should be conducted after the implementation of coordinated care. Adjustment of the model dependent on geographical location (urban vs. rural) could be considered.
关键词：coordinated health care ; patients’ expectations
