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The Role of the Psychosocial Dimension in the Improvement of Quality of Care: A Systematic Review

2015; De Gruyter Open; Volume: 55; Issue: 1 Linguagem: Esloveno

10.1515/sjph-2016-0004

1854-2476

Irena Makivić, Janko Kersnik, Zalika Klemenc–Ketiš,

Healthcare professionals’ stress and burnout

The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic bio-psycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of well-designed intervention studies, and low numbers of included patients limited our conclusions. Priporočen biopsihosocialni pristop poleg biomedicinskega modela bolezni upošteva številne psihološke, socialne in eksistenčne dejavnike. Želeli smo izvedeti, ali v družinski medicini obstajajo dokazi o psihosocialnem pristopu. Cilj našega sistematičnega pregleda je bil analizirati objavljeno literaturo s področja psihosocialne dimenzije dela zdravnika družinske medicine in njegovo povezavo s kakovostjo obravnave bolnikov. Spletno iskanje je potekalo v devetih bazah s pomočjo Boolovih operatorjev in vključenimi kriteriji iskanja, kot so, da članek vsebuje nekaj o celostni medicini, kazalnikih kakovosti, družinski medicini, modelu, usmerjenem na pacienta, ali/in biopsihosocialnem modelu obravnave. Vključeni so bili tudi članki, povezani z družinsko medicino, ki so poročali o meritvah kazalnikov kakovosti. Iskanje je ponudilo 743 zadetkov, od teh je 36 člankov izpolnilo kriterije za vključitev v analizo. Psihosocialna obravnava se je izkazala za uporabno pri preventivi ter pri obravnavi telesnih in psihiatričnih bolezni. Rezultati takšne obravnave so izboljšano socialno funkcioniranje, večje zadovoljstvo pacientov, zmanjšane razlike pri zdravstveni oskrbi in nižji letni stroški zdravljenja. Teme, kot sta osredotočenost na pacienta in psihosocialna medicina, so v člankih kar dobro zastopane. Ni pa bilo možno najti nobenih virov o vplivu celostnega biopsihosocialnega pristopa. Nepopolna in različna definicija psihosocialne dimenzije, majhno število dobro osnovanih intervencijskih raziskav na tem področju in majhno število vključenih pacientov so omejitve, ki so vplivale na sklepe te raziskave.