多学科过渡护理干预措施成功实施的促进因素、障碍和指导:使用实施研究的统一框架进行定性系统回顾

IF 3.1 Q1 NURSING
Romain Collet , Juul van Grootel , Marike van der Leeden , Marike van der Schaaf , Johanna van Dongen , Suzanne Wiertsema , Edwin Geleijn , Mel Major , Raymond Ostelo
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引用次数: 0

摘要

背景:多学科过渡护理干预旨在改善住院期间和出院后具有与身体、营养或心理社会状况相关的复杂护理需求的患者的医疗保健的协调和连续性。实施此类干预措施是复杂的,因为它们涉及多个环境中的许多利益攸关方。许多研究评估了患者、家庭成员和医疗保健专业人员在多学科过渡护理干预方面的经验,这可以深入了解其实施的促进因素和障碍。目的概述实施多学科过渡护理干预的促进因素和障碍,在制定实施策略之前可以考虑这些因素。设计一项使用实施研究统一框架的定性系统评价。设置(s)医院和初级保健参与者入院的成年患者,无论其诊断如何,以及他们的家庭成员、医院和初级保健保健专业人员。方法检索sembase、CINAHL和Medline,通过患者、家庭成员、以及医疗保健专业人员从成立到2024年6月的经验和观点。方法的严谨性通过关键评估技能计划进行评估。我们通过实施研究综合框架确定了成功实施多学科过渡性护理干预措施的促进因素和障碍。促进因素和障碍分为出院前因素、出院后因素和一般因素。结果纳入12项研究并进行评价。我们确定了79个因素,主要与实施研究统一框架的三个领域有关:创新、内部环境和参与的个人。促进因素包括“全面的后续护理需求评估”(出院前)、“即时、量身定制的后续护理”(出院后)和“改善利益相关者之间的沟通”(一般)。障碍包括“医院床位短缺”和“时间不够”(出院前)、“缺乏可用的初级保健专业人员”(出院后)、“利益攸关方时间表不一致”和“干预费用”(一般情况)。结论所确定的因素可以作为一个非详尽的清单,以激励希望在其环境中实施多学科过渡护理干预的读者。数字工具和替代融资模式可能会克服成本和报销问题、患者护理日益复杂以及缺乏可用医院床位或专业人员等缺点。进一步的研究应确定有效的实施策略,考虑到出院前、出院后和确定的一般因素。registrationprotocol在PROSPERO中注册(CRD42023421423)。有效的沟通有助于实施过渡性护理干预措施,但患者护理的复杂性和医疗保健系统的压力提出了挑战。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Facilitators, barriers, and guidance to successful implementation of multidisciplinary transitional care interventions: A qualitative systematic review using the consolidated framework for implementation research

Background

Multidisciplinary transitional care interventions aim to improve the coordination and continuity of healthcare during hospitalization and after discharge for patients with complex care needs related to physical, nutritional, or psychosocial status. Implementing such interventions is complex as they involve many stakeholders across multiple settings. Numerous studies have evaluated patients’, family members’, and healthcare professionals’ experiences with multidisciplinary transitional care interventions, which can provide insight into facilitators and barriers to their implementation.

Objective

To provide an overview of facilitators and barriers to implementing multidisciplinary transitional care interventions, which could be considered before developing implementation strategies.

Design

A qualitative systematic review using the Consolidated Framework for Implementation Research.

Setting(s)

Hospitals and primary care

Participants

Adult patients admitted to a hospital, regardless of their diagnosis, as well as their family members and hospital and primary care healthcare professionals

Methods

Embase, CINAHL, and Medline were searched for qualitative studies evaluating multidisciplinary transitional care interventions through patients', family members', and healthcare professionals' experiences and views from inception until June 2024. The methodological rigor was assessed with the Critical Appraisal Skills Program. We identified facilitators and barriers to the successful implementation of multidisciplinary transitional care interventions with the Consolidated Framework for Implementation Research. Facilitators and barriers were categorized into pre- or post-discharge or general factors.

Results

Twelve studies were included and appraised. We identified 79 factors, mostly linked to three domains of the Consolidated Framework for Implementation Research: Innovation, Inner setting, and Individuals involved. Facilitators included "comprehensive follow-up care needs assessment"(pre-discharge), "immediate, tailored follow-up care"(post-discharge), and "improved communication between stakeholders"(general). Barriers included "shortage of hospital beds" and "lack of time"(pre-discharge), "lack of available primary care professionals"(post-discharge), "inconsistencies of stakeholders' schedules" and "intervention costs"(general).

Conclusions

The factors identified could serve as a non-exhaustive inventory list to inspire readers who wish to implement a multidisciplinary transitional care intervention in their settings. Digital tools and alternative financing models might overcome cost and reimbursement issues, the increasing complexity of patient care, and shortcomings, such as the lack of available hospital beds or professionals. Further research should identify effective implementation strategies, considering the pre-, post-discharge, and general factors identified.

Registration

The protocol was registered in PROSPERO (CRD42023421423).

Tweetable abstract

Effective communication aids in implementing transitional care interventions, but patient care complexity and healthcare system pressures present challenges.
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来源期刊
CiteScore
5.80
自引率
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发文量
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