静脉血栓栓塞预防和管理指南实施的障碍和促进因素：一项混合方法的系统综述。

IF 3.1 Q1 NURSING

International Journal of Nursing Studies Advances Pub Date : 2024-11-27 DOI:10.1016/j.ijnsa.2024.100273

Mengbo Han , Jingying Huang , Jin Yang , Jiaojiao Chen , Haiou Qi

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引用次数: 0

摘要

背景：基于证据的静脉血栓栓塞预防和管理是全球卫生服务的优先事项。静脉血栓栓塞指南的低采用率可能导致患者预后受损。了解临床医生和患者对指南实施的障碍和促进因素的看法，并将已确定的障碍和促进因素映射到实施研究的综合框架中，可以为提高指南采用率的理论干预提供信息。目的：综合定量和定性证据：1)医院临床医生和患者对静脉血栓栓塞治疗的看法和经验；2)指南实施的障碍和促进因素。数据来源：来自MEDLINE， EMBASE， CINAHL， PsycINFO和Cochrane在2012年至2023年间发表的英语研究。方法：纳入的研究主要集中在两个方面：首先，阐明医疗保健提供者和患者对静脉血栓栓塞管理实践的看法和经验；其次，确定影响静脉血栓栓塞指南实施的障碍和促进因素。使用混合方法评估工具进行关键评估。将定量数据转化为定性数据，然后与定性数据进行主题综合，比较临床医生和患者的观点。将与每个主题相关的障碍和促进因素映射到实施研究综合框架中，并将障碍输入其实施策略匹配工具中，以获得实施策略。结果：在8262项不同质量的研究中，26项（定量方法20项，定性方法5项，混合方法1项）符合纳入标准。影响指南实施的因素有四个主题：1)卫生保健主导的多学科预防和管理；2)指南实施的可行性；3)患者参与预防和管理；4)政府和医院环境及相关系统。医疗保健提供者确定的大多数障碍与第二和第四个主题有关，而对于患者来说，第三个主题下存在多个障碍。障碍主要分为干预特征、外部环境、内部环境和个体特征四个领域。医疗保健提供者和患者提到的大多数促进因素与主题1、3和4相关，并映射到三个领域：外部环境、内部环境和个人特征。通过实施研究综合框架-实施变革专家建议匹配工具获得了7个最优实施策略。结论：我们从临床医生和患者的角度强调了与实施静脉血栓栓塞指南相关的最具影响力的因素，并将这些因素映射到实施研究的综合框架中，有助于制定适合利益相关者的实施干预措施。注册：本研究方案已在PROSPERO注册，注册号为CRD42024518184。

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Barriers and facilitators to the implementation of guidelines for venous thromboembolism prevention and management: A mixed-methods systematic review

Background

Evidence-based venous thromboembolism prevention and management is a priority for global health services. Low adoption of venous thromboembolism guidelines can result in compromised patient outcomes. Understanding clinicians' and patients' perceptions of barriers to and facilitators for guideline implementation and mapping identified barriers and facilitators to the Consolidated Framework for Implementation Research may inform theoretical interventions to improve guideline adoption rates.

Objective

To synthesize quantitative and qualitative evidence on both 1) perceptions and experiences of hospital clinicians and patients regarding venous thromboembolism practices and 2) barriers to and facilitators for guideline implementation.

Data source

English-language studies from MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane published between 2012 and 2023.

Methods

The included studies primarily focused on two aspects: firstly, elucidating the perceptions and experiences of healthcare providers and patients concerning venous thromboembolism management practices, and secondly, identifying the barriers and facilitators that influence the implementation of venous thromboembolism guidelines. The Mixed Methods Appraisal Tool was used for critical appraisal. Quantitative data were transformed into qualitized data and then thematically synthesized with qualitative data to compare the perspectives of clinicians and patients. Barriers and facilitators related to each topic were mapped to the Consolidated Framework for Implementation Research, and the barriers were entered into its implementation strategy matching tool to obtain implementation strategies.

Results

Of 8262 studies of varying quality, 26 (20 quantitative, five qualitative, and one mixed-methods) met the inclusion criteria. Four themes represented factors influencing guideline implementation: 1) healthcare-led multidisciplinary prevention and management, 2) feasibility of guideline implementation, 3) patient involvement in prevention and management, and 4) government and hospital environments and related systems. The majority of barriers identified by healthcare providers were related to the second and fourth themes, while for patients, there were multiple barriers under the third theme. Barriers were mainly mapped into four domains: intervention characteristics, outer setting, inner setting, and characteristics of individuals. Most facilitators mentioned by healthcare providers and patients were related to themes 1, 3, and 4 and mapped to three domains: outer setting, inner setting, and characteristics of individuals. Seven optimal implementation strategies were obtained through the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool.

Conclusions

We highlighted the most influential factors associated with implementing venous thromboembolism guidelines from the perspectives of both clinicians and patients, and mapping these factors to the Consolidated Framework for Implementation Research can help to develop stakeholder-appropriate implementation interventions.