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Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration.

初级保健中的卒中随访: 出院总结作为知识转移和协作工具的话语研究。

  • 影响因子:2.26
  • DOI:10.1186/s12913-020-06021-8
  • 作者列表:"Pedersen RA","Petursson H","Hetlevik I","Thune H
  • 发表时间:2021-01-07
Abstract

BACKGROUND:The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. METHODS:The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines' recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.  RESULTS: We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. CONCLUSIONS:The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

摘要

背景: 中风的急性治疗在医院进行,在挪威,对居住在社区的中风幸存者的随访主要在一般实践中进行。为了提供持续的卒中后护理,这两个级别的护理必须协作,并且必须在它们之间传递信息和知识。出院总结是医院的书面报告,是此次沟通的核心。因此,2010年发布的挪威国家卒中治疗指南对出院总结的内容提出了建议。一个目标是实现协作和知识转移,促进医疗保健服务的整合。然而,研究表明,在一般实践中坚持指导方针是薄弱的,医疗保健服务内部的合作没有按照当局的意愿进行,并且医疗保健服务是分散的。本研究旨在评估出院总结在多大程度上符合指南建议的内容,以及它们在多大程度上被用作知识转移和二级和初级保健之间合作的工具。 方法: 本研究对54例居家脑卒中患者的出院总结进行分析。这些患者分别于2011年和2012年从两家挪威当地医院出院,并在初级保健中进行随访。我们检查了内容是否符合指南的建议,并使用适应于既定语篇分析综合方法的工具进行了描述性和解释性语篇分析。结果: 我们发现对出院总结内容的不同建议有不同程度的依从性。一个趋势是明确的: 这里和现在相关的主题,即在医院,被包括在内,而与初级保健的后期随访最相关的主题在更大程度上被忽略。在大多数出院总结中,我们没有发现任何迹象表明医院的医生在患者出院后可以与初级保健合作。 结论: 出院总结没有发挥其作为协作、知识转移和指南实施工具的潜力。相反,它们可能有助于维持医院医学和一般实践之间的差距。

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