在一般实践中优化个人连续性:一个工具包的过程评估
Lex Jozef Johannes Groot1, Annemarie A Uijen2, Henk Schers3
1Amsterdam UMC Locatie VUmc, General Practice, Amsterdam, Netherlands.
概括
工具包干预的目的是改善老年人在一般实践中的个人连续性. 尽管面临员工短缺等挑战,但它提高了工作程序,并对大多数参与实践的连续性产生了持续的积极影响.
科学领域:
- 实施科学 实施科学
- 一般实践研究研究 一般实践研究
- 医疗保健管理的管理
背景情况:
- 在初级保健中,与全科医生的个人连续性至关重要,但越来越受到挑战.
- 该TOOL-kit干预方案是为了优化65岁及以上患者的个人连续性而开发的.
- 社会和医疗保健的变化需要新的策略来维持患者与提供者之间的关系.
研究的目的:
- 评估多组件TOOL-kit干预措施的实施情况.
- 确定影响TOOL套件交付的障碍和促进者.
- 评估在一般实践中对老年成人患者个人连续性的影响.
主要方法:
- 一个混合方法研究嵌入在一个主要效果试验.
- 数据收集包括3个月一次的调查和93次与32个全科医生和实践人员 (n=221) 的面试.
- 评估重点是招募,覆盖范围,忠诚度,输送/接收剂量,以及多个层面的障碍/促进者.
主要成果:
- 在32个实践中,有23个实践遵守了协议;然而,在17个实践中,TOOL套件的剂量很低.
- 在研究结束时,55%的实践目标得到了实现,19个实践在24个月后对个人连续性产生了持续的积极影响.
- 强大的质量改进基础设施促进了实施,而工作压力和人员短缺 (由COVID-19加剧) 是关键障碍.
结论:
- 尽管存在实施方面的挑战,TOOL-kit干预表明了提高工作程序的能力,并专注于个人连续性.
- 在大多数遵守该协议的实践中,观察到个人连续性的持续改善.
- 建议加强质量改进基础设施和决策流程,以改善未来的实施成功.
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