利用理论领域框架来确定在非膜心房动中基于证据的建议的障碍
Evan White1, Sandra L Kane-Gill1, Sandeep Jain2
1School of Pharmacy, Department of Pharmacy and Therapeutics, University of Pittsburgh, Pittsburgh, PA, USA.
The Annals of pharmacotherapy
|November 27, 2024
概括
由于知识差距,成本,患者拒绝和社会因素,临床人员对抗凝血药物治疗心房动 (AF) 准则的遵守率较低. 干预措施可以解决这些障碍,以改善护理.
科学领域:
- 实施科学 实施科学
- 行为科学是一种行为科学.
- 临床实践指南 临床实践指南
背景情况:
- 在患者护理中,基于证据的指导方针的实施面临着显著的效率低下,只有14%的新研究被例行采用.
- 在心房的指导方针中,建议根据CHA 2 DS 2 -VASc得分进行抗凝血治疗,但处方率仍然很低,为51%.
- 现有的框架,如理论领域框架 (TDF),被用来识别准则采用所需的行为变化.
研究的目的:
- 探索阻碍临床医生遵守非膜动 (NVAF) 基于证据的建议的行为主题和障碍.
- 开发有针对性的干预措施,以克服已识别的障碍,并改善对NVAF患者的适当抗凝药处方.
主要方法:
- 与参与NVAF护理的多学科利益相关者进行了9次专题采访.
- 利用基于TDF的采访问题来识别必要的行为变化,以增加抗凝血和减少住院患者.
- 使用NVivo 12软件转录和编码采访,以确定主题和开发干预措施.
主要成果:
- 在TDF的"知识"和"环境背景和资源"领域中确定了四个主要障碍主题.
- 关键障碍包括缺乏知识,抗凝药的成本,患者拒绝和健康的社会决定因素.
- 这些障碍影响了适当的NVAF管理和抗凝药处方.
结论:
- 该TDF框架有效地确定了潜在的障碍,导致NVAF患者使用抗凝血剂不足.
- 行为改变干预技术可以应用于解决这些已识别的障碍.
- 解决这些障碍对于改善NVAF的指导方针遵守和患者结果至关重要.
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