자연주의적 탐구조사(Naturalistic Inquiry)

Basics of qualitative research: Grounded theory procedures and techniques

Lincoln, Yvonna, and Egon Guba, "Postpositivism and the Naturalist Paradigm," pp. 14-46 in Yvonna Lincoln and Egon Guba, Naturalistic Inquiry . Beverly Hills, CA: Sage, 1985.*

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(12)60240-2.pdf

Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study

การวจยเชงคณภาพ เปนเครองมอสำคญอยางหนงสำหรบทำความเขาใจสงคมและพฤตกรรมมนษย การวจยแบบการสรางทฤษฎจากขอมล กเปนหนงในหลายระเบยบวธการวจยเชงคณภาพทกำลงไดรบความสนใจ และเปนทนยมเพมสงขนเรอยๆ จากนกวชาการ และนกวจยในสาขาสงคมศาสตร และศาสตรอนๆ เชน พฤตกรรมศาสตร สงคมวทยา สาธารณสขศาสตร พยาบาลศาสตร จตวทยาสงคม ศกษาศาสตร รฐศาสตร และสารสนเทศศกษา ดงนน หนงสอเรอง “ConstructingGrounded Theory: A Practical Guide through Qualitative Analysis” หรอ “การสรางทฤษฎจากขอมล:แนวทางการปฏบตผานการวเคราะหเชงคณภาพ” จะชวยใหผอานมความรความเขาใจถงพฒนาการของปฏบตการวจยแบบสรางทฤษฎจากขอมล ตลอดจนแนวทาง และกระบวนการปฏบตการวจยอยางเปนระบบ จงเปนหนงสอทควรคาแกการอานโดยเฉพาะนกวจยรนใหม เพอเปนแนวทางในการนำความรความเขาใจไประยกตในงานวจยของตน อกทงนกวจยผเชยวชาญสามารถอานเพอขยายมโนทศนดานวจยใหกวางขวางขน

Constructing Grounded Theory: A Practical Guide through Qualitative Analysis

Background In developed countries, primary health care increasingly involves the care of patients with multiple chronic conditions, referred to as multimorbidity. Aim To describe the epidemiology of multimorbidity and relationships between multimorbidity and primary care consultation rates and continuity of care. Design of study Retrospective cohort study. Setting Random sample of 99 997 people aged 18 years or over registered with 182 general practices in England contributing data to the General Practice Research Database. Method Multimorbidity was defined using two approaches: people with multiple chronic conditions included in the Quality and Outcomes Framework, and people identified using the Johns Hopkins University Adjusted Clinical Groups (ACG®) Case-Mix System. The determinants of multimorbidity (age, sex, area deprivation) and relationships with consultation rate and continuity of care were examined using regression models. Results Sixteen per cent of patients had more than one chronic condition included in the Quality and Outcomes Framework, but these people accounted for 32% of all consultations. Using the wider ACG list of conditions, 58% of people had multimorbidity and they accounted for 78% of consultations. Multimorbidity was strongly related to age and deprivation. People with multimorbidity had higher consultation rates and less continuity of care compared with people without multimorbidity. Conclusion Multimorbidity is common in the population and most consultations in primary care involve people with multimorbidity. These people are less likely to receive continuity of care, although they may be more likely to gain from it.

Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study

PURPOSE Many patients consulting in primary care have multiple conditions (multimorbidity). Aims of this review were to identify measures of multimorbidity and morbidity burden suitable for use in research in primary care and commu- nity populations, and to investigate their validity in relation to anticipated asso- ciations with patient characteristics, process measures, and health outcomes. METHODS Studies were identifi ed using searches in MEDLINE and EMBASE from inception to December 2009 and bibliographies. RESULTS Included were 194 articles describing 17 different measures. Commonly used measures included disease counts (n = 98), Chronic Disease Score (CDS) / RxRisk (n = 17), Adjusted Clinical Groups (ACG) System (n = 25), the Charlson index (n = 38), the Cumulative Index Illness Rating Scale (CIRS; n = 10) and the Duke Severity of Illness Checklist (DUSOI; n = 6). Studies that compared measures sug- gest their predictive validity for the same outcome differs only slightly. Evidence is strongest for the ACG System, Charlson index, or disease counts in relation to care utilization; for the ACG System in relation to costs; for Charlson index in relation to mortality; and for disease counts or Charlson index in relation to quality of life. Simple counts of diseases or medications perform almost as well as complex mea- sures in predicting most outcomes. Combining measures can improve validity. CONCLUSIONS The measures most commonly used in primary care and com- munity settings are disease counts, Charlson index, ACG System, CIRS, CDS, and DUSOI. Different measures are most appropriate according to the outcome of interest. Choice of measure will also depend on the type of data available. More research is needed to directly compare performance of different measures.

https://www.annfammed.org/content/annalsfm/10/2/134.full.pdf

Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide

Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians.

Despite considerable efforts to reduce emergency admissions, only a minority of primary care trusts (PCTs) succeeded in doing so between 2007/8 and 2008/9 (Gillam 2010). The average increase in admissions during this time was 5 per cent across all PCTs, ranging from a 12.7 per cent decrease to a 27.3 per cent increase. In order to successfully reduce avoidable emergency admissions, we need to fully understand which interventions are the most effective.

Avoiding hospital admissions. What does the research evidence say

Objectives To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. Setting Observational studies at primary care practice level. Participants Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. Primary and secondary outcome measures The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. Results 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. Conclusions The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions.

https://bmjopen.bmj.com/content/bmjopen/4/5/e004746.full.pdf

Sarah Purdy

Papers

Epidemiology and impact of multimorbidity in primary care: a retrospective cohort study

Measures of multimorbidity and morbidity burden for use in primary care and community settings: A systematic review and guide

Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians.

Avoiding hospital admissions. What does the research evidence say

Which features of primary care affect unscheduled secondary care use?: A systematic review