一般实践中的复杂预先护理规划干预 (ACP-GP):一个集群随机对照试验
Julie Stevens1, Rose Miranda2, Peter Pype3
1End-of-Life Care Research Group, VUB & Universiteit Gent, Brussels; Department of Family Medicine and Chronic Care, VUB, Brussels; Department of Public Health and Primary Care, Universiteit Gent, Ghent.
概括
一般实践中的预先护理规划 (ACP) 复杂干预措施与常规护理相比,并没有显著改善患者参与或GP的自我有效性. 两组都出现了一些改善,可能受试验程序和COVID-19大流行影响.
科学领域:
- 老年学是一门学科.
- 主要护理医学 医疗保健
- 医疗保健服务研究 医疗服务研究
背景情况:
- 预先护理计划 (ACP) 对于患有慢性,终身疾病的患者来说至关重要,以沟通未来的护理偏好.
- 在一般实践中,在患者,全科医生和系统层面有效实施ACP面临重大障碍.
- 复杂的干预措施可能是必要的,以克服这些障碍,并促进ACP.
研究的目的:
- 评估在一般实践环境下实施的复杂ACP干预 (ACP-GP) 的有效性.
- 评估ACP-GP干预措施对患者参与事先护理规划的影响.
- 确定ACP-GP干预对一般医生 (GPs) 进行ACP的自我有效性的影响.
主要方法:
- 一个集群随机对照试验在比利时的全科医院进行.
- 该干预 (ACP-GP) 包括一个患者工作簿,GP培训,专门的ACP对话和一个文档模板.
- 结果包括ACP患者参与度 (ACP参与度调查) 和GP自效率 (ACP自效度表),在基线后3个月和6个月使用线性混合模型进行评估.
主要成果:
- 在3个月或6个月后,干预组和对照组之间没有发现患者的ACP参与度的统计学上显著差异.
- 同样,在任何时间点,GP ACP的自我有效性在两组之间都没有明显的差异.
- 干预组和对照组都表现出与基线相比,结果的总体增加.
结论:
- 在提高患者参与度或GP自我有效性方面,ACP-GP干预并没有显示出比常规护理更高的有效性.
- 试验程序和COVID-19大流行等因素可能无意中增加了对ACP的认识和参与.
- 可能需要进一步的研究来完善复杂的干预措施,以便在初级保健机构有效实施.
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