如何在社区环境中促进和维持以团队为基础的老年人护理整合中的跨专业合作?现实主义证据综合。

IF 6.3 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Deirdre O'Donnell, Carmel Davies, Catherine Devaney, Apolonia Radomska, Marie O'Shea, Gráinne O'Donoghue, Aoife De Brún, Sarah Donnelly, Helen Whitty, P J Harnett, Deirdre Lang, Emer Ahern, Sahar Hammoud, Éidín Ní Shé
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引用次数: 0

摘要

背景:以社区为中心的老年人综合护理是世卫组织老年人综合护理实施框架的基石。要实现老年人护理一体化的潜力,就需要在团队内部和团队之间进行服务协调和专业间合作(IPC)。在了解如何在以团队为基础的老年人社区护理整合中促进和维持IPC方面的研究证据存在差距。我们报告了一项现实证据综合,以确定支持跨专业社区老年人护理团队中IPC的环境影响和机制。方法:现实主义综合的三个阶段包括研究证据的探索性范围和与四个当地利益相关者团体协商,以产生初步的方案理论。第二阶段涉及系统地检索和综合证据,包括同行评议的已发表的实证研究和专家小组推荐的灰色文献。第三阶段涉及发展具有利益相关者验证的精炼程序理论。利益攸关方群体包括老年人和护理人员的代表、保健专业人员和社区专家老年人团队的业务经理、国家决策者和方案管理人员。结果:在七个项目理论领域中确定了IPC及其相关结果的资源和推理机制:(1)专业认同和成长,(2)跨界信息共享和护理协调,(3)有效的运营和临床治理,(4)发展团队学习文化,(5)老年人和护理人员的有意义包容,(6)质量改进和项目开发,(7)劳动力规划和保留。结论:研究结果为政策制定者和临床医生提供了基于证据的规划理论,将促进关于IPC实施的关键对话。这一规划理论为资源的优先排序提供了信息,为IPC干预措施的成功发展和实施创造了有利的环境。这项研究补充并扩展了世卫组织ICOPE实施框架中提出的工作。我们鼓励在不同的卫生系统背景下在当地实际应用和评价规划理论。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How can interprofessional collaboration be fostered and sustained in team-based care integration for older people in community settings? A realist evidence synthesis.

Background: Community-centred care integration for older adults is a cornerstone of the WHO's Integrated Care for Older People (ICOPE) implementation framework. Realising the potential of care integration for older people requires cohesive coordination of services and interprofessional collaboration (IPC) within and across teams. There is a gap in research evidence to understand how IPC can be fostered and sustained within team-based community care integration for older people. We report on a realist evidence synthesis to identify the contextual influences and mechanisms that support IPC in interprofessional community care teams for older people.

Methods: The three phases of the realist synthesis included an exploratory scoping of research evidence and consultation with four local stakeholder groups to produce initial programme theories. The second phase involved systematic retrieval and synthesis of evidence, including peer-reviewed published empirical studies and grey literature recommended by an expert panel. The third phase involved the development of refined programme theory with stakeholder validation. The stakeholder cohorts included representatives of older people and caregivers, healthcare professionals and operational managers of community specialist older person teams, national policymakers, and programme managers.

Results: The resource and reasoning mechanisms that enable contexts for IPC and their associated outcomes are identified within seven programme theory areas: (1) professional identity and growth, (2) information sharing and care coordination across boundaries, (3) effective operational and clinical governance, (4) developing a team learning culture, (5) meaningful inclusion of older people and caregivers, (6) quality improvement and programme development, (7) workforce planning and retention.

Conclusions: The results provide policymakers and clinicians with evidence-based programme theory that will catalyse critical dialogue on IPC implementation. This programme theory informs the prioritisation of resources to enable favourable contexts for successful IPC intervention development and implementation. This research complements and expands the work presented in the WHO ICOPE implementation framework. We encourage local realist application and evaluation of the programme theory within varying health system contexts.

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来源期刊
Systematic Reviews
Systematic Reviews Medicine-Medicine (miscellaneous)
CiteScore
8.30
自引率
0.00%
发文量
241
审稿时长
11 weeks
期刊介绍: Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies. The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.
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