临床医生对阻塞性睡眠呼吸暂停护理促进因素与障碍观点的定性探索。

文献信息

中文摘要

背景： 文献提示儿童在阻塞性睡眠呼吸障碍（SDB）的诊断和治疗方面存在很大差异，然而，临床医生对护理障碍和促进因素的多学科观点尚未得到很好的阐明。
方法： 这项定性研究遵循了定性研究统一报告标准（COREQ）指南。参与者被招募直至在整个数据集中达到主题饱和。对来自初级保健、耳鼻喉科和睡眠医学的医生和高级实践提供者进行了关键信息提供者访谈，这些提供者来自农村和城市环境的学术和社区实践。访谈记录采用演绎-归纳相结合的主题方法进行分析。
结果： 16名临床医生参与（62.5%为女性，50%为私人执业 vs 学术机构，平均执业年限12.6年[SD 7.1]），其中56%为初级保健提供者，31%为耳鼻喉科医生，13%为睡眠医学专家。SDB护理提供的多层次障碍使用社会生态模型进行组织。在初级保健提供者中，SDB的管理差异很大，临床实践指南的使用有限。转诊决定受到专科医生地理可及性的影响。对于服务大量西班牙语人群的临床医生，他们经常将语言障碍描述为对父母互动产生负面影响的 important 障碍。多导睡眠监测的可及性有限是所有学科临床医生指出的最重要障碍，并导致了提供者建议和临床路径的改变。
结论： 这项定性研究提供了多学科临床医生在社会生态框架下对儿科睡眠呼吸障碍（SDB）护理障碍和促进因素的观点。研究结果确定了塑造护理路径的多层次因素，并强调了改善可及性的可行机会，包括加强照护者教育、标准化转诊实践、扩大多导睡眠监测的可及性，以及通过循证指导和多学科合作给予临床医生更大支持。

英文摘要

BACKGROUND: Literature has suggested that children experience wide variation in diagnosis and treatment of obstructive sleep-disordered breathing (SDB), however, multidisciplinary perspectives on barriers and facilitators to care are not well delineated among clinicians.
METHODS: This qualitative study adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Participants were recruited until thematic saturation was achieved across the overall dataset. Key informant interviews were conducted with physicians and advanced practice providers from primary care, otolaryngology, and sleep medicine across academic and community practices in both rural and urban settings. Interview transcripts were analyzed using a combined deductive-inductive thematic approach.
RESULTS: Sixteen clinicians participated (62.5% female, 50% private vs academic, mean years in practice 12.6 [SD 7.1]), of whom were 56% primary care providers, 31% otolaryngologists, and 13% sleep medicine specialists. Multilevel barriers to SDB care delivery were organized using the socioecological model. Among primary care providers, management of SDB varied considerably with limited use of clinical practice guidelines. Decisions to make a referral were influenced by geographic access to specialists. For clinicians with a large Spanish-speaking population, they frequently described language barriers as important obstacles that negatively affected parental interactions. Limited access to polysomnography was the most significant barrier noted by clinicians in all disciplines and led to changes in provider recommendations and clinical pathways.
CONCLUSION: This qualitative study provides multidisciplinary clinician perspectives on barriers and facilitators to pediatric sleep-disordered breathing (SDB) care across the socioecological framework. The findings identify multilevel factors that shape care pathways and highlight actionable opportunities to improve access, including enhanced caregiver education, standardized referral practices, expanded access to polysomnography, and greater support for clinicians through evidence-based guidance and multidisciplinary collaboration.