全科医学安宁疗护多专业团队服务模式构建及效果研究

Exploration and Effect of Hospice Care by the Hospice Multiple Professional Team in Support of General Practice

背景安宁疗护已成为国家健康体系中的重要环节。2017年以来国家卫生主管部门主导开展了两个批次的全国安宁疗护试点,共计1个直辖市及76个城市(区)成为试点单位。然而,作为安宁疗护主要服务提供者和主要服务场所的社区卫生机构,目前尚未形成切实可行的服务模式,亟须探索研究。目的基于社区卫生工作实际,组建全科医学背景下安宁疗护多专业团队,确立团队成员角色,探索安宁疗护多专业团队服务模式(H-MPT)并评估其运行效果。方法本研究采用定量与定性混合研究设计对2016年10月—2019年12月在康健安宁疗护开展的H-MPT进行效果评估。定量研究采用自行编制的“H-MPT团队成员评估表”“H-MPT服务患者家属评估表”。定性研究的开展则采用自编访谈提纲,对H-MPT团队成员中的医生、护士进行录音访谈。对量表评估和访谈结果进行描述性统计。结果量表评估结果显示,团队成员对各条目的评估值为4.58~5.00分,患者家属对各条目的评估值为4.60~5.00分。访谈结果显示,H-MPT服务模式提升了人文关怀服务质量、提高了团队协作效率、有助于改善医患关系及提升对医务社会工作者的认可。结论基于全科医学平台组建安宁疗护多专业团队的服务模式,不仅提升了安宁疗护的总体服务质量,而且为当下开展社区为本的安宁疗护提供一个专业服务的框架。

Background In China,hospice care has become an important part of the national healthcare system.Since the year of 2017,the national health authorities have initiated two rounds of implementing hospice care at the national level with 1 municipality,and 76 cities/districts as the pilot areas.However,there is no available practical pattern for delivering hospice care by community healthcare institutions,a major kind of healthcare settings for delivering such services,which needs to be explored urgently.Objective To establish a hospice multiple professional team(H-MPT)in support of general practice with determined roles of team members for delivering hospice care in community healthcare settings,and to assess the management effect of the team.Methods A quantitative and qualitative mixed design was used to evaluate the effect of hospice care delivered by a H-MPT in Kangjian Subdistrict Community Health Centre from October 2016 to December 2019.Two selfmade questionnaires,the H-MPT Team Member Assessment Form and Patient's Family Members'Assessment of H-MPT Services were used in the quantitative study.Interviews with self-developed outlines were used in the qualitative study.Descriptive statistical analyses of questionnaire assessment results and recorded interview results were performed.Results The members of the H-MPT had scores ranging from 4.58 to 5.00 in terms of each assessment item.The scores of the effect of hospice care delivered by the H-MPT evaluated by patients'family members ranged from 4.60 to 5.00 in terms of each assessment item.The interviews indicated that hospice care delivered by the H-MPT significantly improved the quality of humanistic care services,efficiency of team cooperation,and doctor-patient relationship as well as the recognition of medical social workers.Conclusion The H-MPT established for supporting general practice to offer hospice care may significantly improve the quality of hospice care.Moreover,this pattern may provide a referential practical framework for the delivery of community-based hospice care in China.