Lost in fragmentation — care coordination when somatic symptoms persist: a qualitative study of patients’ experiences

The British journal of general practice: the journal of the Royal College of General Practitioners

article

Hieke Barends¹  Femke Botman¹  Ella Walstock¹  Nikki Claassen-van Dessel¹  Johannes C van der Wouden¹  Tim olde Hartman²  Joost Dekker³  Henriëtte E van der Horst¹ 

[1] Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute;Department of Primary and Community Care, Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center;Amsterdam Public Health Research Institute, Amsterdam, and Department of Rehabilitation Medicine and Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam

关键词: coordination of care;    general practice;    medically unexplained symptoms;    persistent somatic symptoms;    primary care;    qualitative research;   

DOI  :  10.3399/BJGP.2021.0566

学科分类：卫生学

来源: Royal College of General Practitioners

【 摘 要 】

Background GPs can play a central role in the care of patients with persistent somatic symptoms (PSS). To date, little is known about these patients’ experiences relating to their coordination of care.Aim To explore the experiences of patients with PSS relating to coordination of care — in particular by their GP — during their illness trajectory.Design and setting This qualitative study was carried out from January to April 2019 in the Netherlands as part of a multicentre prospective cohort study on the course of PSS (PROSPECTS).Method Thematic content analysis of 15 interviews.Results Three themes were identified: care fragmentation during the diagnostic trajectory; transition from the search for a cure to coping; and reframing to coping: GPs’ role in facilitating supportive care. Patients experienced a lack of collaboration from healthcare workers during the diagnostic trajectory. Guidance by their GP in a process of shared decision making was positively valued by patients. Moving the focus from searching for a cure to coping with symptoms was described as a ‘personal endeavour’, made even more challenging by the ongoing uncertainty experienced by patients. When reframing to coping, the extent to which patients felt aligned with their GP played an important role in whether their supportive care request was met.Conclusion Patients experienced difficulties when navigating the diagnostic trajectory and shifting to coping. The findings of this study underline the importance of collaboration between GPs and other healthcare professionals during the diagnostic trajectory. The authors recommend that GPs provide proactive guidance and are sensitive to patients who shift to coping by providing them with supportive care in a process of shared decision making.

【 授权许可】

Free