Implementing and evaluating care and support planning: a qualitative study of health professionals’ experiences in public polyclinics in Singapore

BMC Primary Care

Research

E Shyong Tai¹  Tong Wei Yew¹  Victor Weng Keong Loh²  Sharon McCann³  Vikki A. Entwistle⁴  Wee Hian Tan⁵ 

[1]Department of Medicine, National University Hospital, Singapore, Singapore

[2]Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

[3]Division of Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

[4]Department of Family Medicine, National University Health System, Singapore, Singapore

[5]Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, Scotland, UK

[6]Health Services Research Unit, Health Sciences Building, University of Aberdeen, Foresterhill, AB25 2ZD, Aberdeen, Scotland, UK

[7]School of Divinity, History, Philosophy and Art History, University of Aberdeen, Aberdeen, Scotland

[8]Centre for Biomedical Ethics, National University of Singapore, Singapore, Singapore

[9]National University Polyclinics, National University Health System, Singapore, Singapore

关键词: Self-management support;    Care and support planning;    Diabetes;    Professional-patient relations;    Person-centred care;    Qualitative interviews;    Professional education;    Continuity of care;    Healthcare improvement;   

DOI  :  10.1186/s12875-023-02168-5

 received in 2022-09-04, accepted in 2023-10-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundTwo polyclinics in Singapore modified systems and trained health professionals to provide person-centred Care and Support Planning (CSP) for people with diabetes within a clinical trial. We aimed to investigate health professionals’ perspectives on CSP to inform future developments.MethodsQualitative research including 23 semi-structured interviews with 13 health professionals and 3 co-ordinators. Interpretive analysis, including considerations of how different understandings, enactments, experiences and evaluative judgements of CSP clustered across health professionals, and potential causal links between them.ResultsBoth polyclinic teams introduced CSP and sustained it through COVID-19 disruptions. The first examples health professionals gave of CSP ‘going well’ all involved patients who came prepared, motivated and able to modify behaviours to improve their biomedical markers, but health professionals also said that they only occasionally saw such patients in practice. Health professionals’ accounts of how they conducted CSP conversations varied: some interpretations and reported enactments were less clearly aligned with the developers’ person-centred aspirations than others. Health professionals brought different communication skill repertoires to their encounters and responded variably to challenges to CSP that arose from: the linguistic and educational diversity of patients in this polyclinic context; the cultural shift that CSP involved; workload pressures; organisational factors that limited relational and informational continuity of care; and policies promoting biomedical measures as key indicators of healthcare quality. While all participants saw potential in CSP, they differed in the extent to which they recognised relational and experiential benefits of CSP (beyond biomedical benefits), and their recommendations for continuing its use beyond the clinical trial were contingent on several considerations. Our analysis shows how narrower and broader interpretive emphases and initial skill repertoires can interact with situational challenges and respectively constrain or extend health professionals’ ability to refine their skills with experiential learning, reduce or enhance the potential benefits of CSP, and erode or strengthen motivation to use CSP.ConclusionHealth professionals’ interpretations of CSP, along with their communication skills, interact in complex ways with other features of healthcare systems and diverse patient-circumstance scenarios. They warrant careful attention in efforts to implement and evaluate person-centred support for people with long-term conditions.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023