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What causes treatment failure - the patient, primary care, secondary care or inadequate interaction in the health services?

机译:是什么原因导致治疗失败-患者,初级保健,二级保健或医疗服务中的相互作用不足?

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Background Optimal treatment gives complete relief of symptoms of many disorders. But even if such treatment is available, some patients have persisting complaints. One disorder, from which the patients should achieve complete relief of symptoms with medical or surgical treatment, is gastroesophageal reflux disease (GERD). Despite the fact that such treatment is cheap, safe and easily available; some patients have persistent complaints after contact with the health services. This study evaluates the causes of treatment failure. Methods Twelve patients with GERD and persistent complaints had a semi-structured interview which focused on the patients' evaluation of treatment failure. The interviews were taped, transcribed and evaluated by 18 physicians, (six general practitioners, six gastroenterologists and six gastrointestinal surgeons) who completed a questionnaire for each patient. The questionnaires were scored, and the relative responsibility for the failure was attributed to the patient, primary care, secondary care and interaction in the health services. Results Failing interaction in the health services was the most important cause of treatment failure, followed by failure in primary care, secondary care and the patient himself; the relative responsibilities were 35%, 28%, 27% and 10% respectively. There was satisfactory agreement about the causes between doctors with different specialities, but significant inter-individual differences between the doctors. The causes of the failures differed between the patients. Conclusions Treatment failure is a complex problem. Inadequate interaction in the health services seems to be important. Improved communication between parts of the health services and with the patients are areas of improvement.
机译:背景技术最佳治疗可以完全缓解许多疾病的症状。但是,即使有这种治疗方法,一些患者仍会持续抱怨。胃食管反流病(GERD)是患者应通过药物或手术治疗完全缓解症状的一种疾病。尽管这种治疗便宜,安全并且容易获得;一些患者在与卫生服务机构联系后会持续抱怨。这项研究评估了治疗失败的原因。方法对12名患有GERD和持续性不适的患者进行半结构式访谈,重点是对患者治疗失败的评估。访谈由18位医师(六位全科医生,六位胃肠病医师和六位胃肠外科医生)进行录音,转录和评估,他们为每位患者填写了一份问卷。对问卷进行评分,失败的相对责任归因于患者,初级保健,二级保健以及卫生服务中的互动。结果卫生服务中失败的互动是治疗失败的最重要原因,其次是初级保健,二级保健和患者本人的失败。相对责任分别为35%,28%,27%和10%。不同专业的医生之间的病因达成了令人满意的共识,但是医生之间的个体差异很大。失败的原因因患者而异。结论治疗失败是一个复杂的问题。保健服务中的互动不足似乎很重要。改善卫生服务部分之间以及与患者之间的沟通是需要改进的领域。

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