影响血管外科医生遵守腹腔大动脉动脉瘤选择性修复指南的因素:一种定性研究
Michelle Brust1, Laurens C van Gestel2, Patrick W H E Vriens3
1Department of Public Health and Primary Care, Health Campus The Hague, Leiden University Medical Centre, The Hague, the Netherlands.
概括
由于患者因素,时间限制和系统激励,血管外科医生在推门之前进行腹腔大动脉动脉瘤 (AAA) 修复. 解决这些影响可以改善准则的遵守,以获得更好的患者结果.
科学领域:
- 血管外科 血管外科
- 行为科学 行为科学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 选择性腹腔大动脉瘤 (AAA) 修复仅在直径超过干预值时才推.
- 很大一部分AAA维修比指导方针建议的更早进行.
- 了解外科医生的行为对于改善遵守AAA修复指南至关重要.
研究的目的:
- 探索影响血管外科医生遵守AAA修复干预门的因素.
- 采用行为科学视角来分析AAA修复时间的决策.
- 确定在AAA管理中遵守准则的障碍和促进者.
主要方法:
- 使用半结构面试对来自荷兰30家医院的12名血管外科医生的定性研究.
- 利用理论领域框架 (TDF) 和COM-B模型来指导行为科学方法.
- 采访数据的专题分析是使用ATLAS.ti进行的,代码是通过诱导和演获得的.
主要成果:
- 外科医生对早期AAA修复的决定各不相同,有些理由是以患者为中心,而另一些则认为这是不良的做法.
- 关键的影响因素包括外科医生沟通,测量知识,时间限制,患者压力,对风险的信念,退款激励以及对警等待的感知能力.
- 建议的改进包括破裂风险预测工具,关于值的最新研究和增强的患者支持.
结论:
- 血管外科医生对干预门附近的AAA修复时间的决定是复杂的,受能力,机会和动机的影响.
- 解决这些多方面的因素可以改善对基于证据的指导方针的遵守.
- 加强对指导方针的遵守可以导致更一致的实践和改善AAA管理中的患者结果.
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