El Fakiri Fatima, Hoes Arno W, Uitewaal Paul J M, Frenken Rianne A A, Bruijnzeels Marc A
Department of Health Policy and Management, Erasmus Medical Centre Rotterdam, Netherlands.
Eur J Cardiovasc Nurs. 2008 Dec;7(4):296-302. doi: 10.1016/j.ejcnurse.2008.01.002. Epub 2008 Mar 4.
A RCT, conducted to examine the effectiveness of a structured collaboration in general practice to provide intensified preventive care in patients at high cardiovascular risk yielded no effect in the total group but differences across healthcare centres and ethnic groups become apparent. We conducted a process evaluation to explain these differences.
We assessed the reach of the target group and whether key intervention components (individual educational sessions, structured team meetings, and risk assessments) were performed as planned (maximum score for protocol completion is 11).
The reach was initially 91%, but only a minority of patients completed the intervention activities as planned. The average score of the number of intervention components was low (5.66 out of 11 (sd 2.8)) and varied between centres (4.84 to 7.40) and ethnic groups (4.89 to 7.38), with team meetings as the least implemented activity conform plan.
This study indicates that adding a practice nurse and a peer health educator to the general practice did not seem to result in the desired collaboration between the healthcare personnel. Further research is needed to investigate the reasons behind the low participation rate of the patients in the intervention.
一项随机对照试验旨在检验在全科医疗中开展结构化协作以向心血管疾病高风险患者提供强化预防保健的效果，结果显示在总体人群中未取得成效，但各医疗中心和不同种族群体之间的差异却很明显。我们进行了一项过程评估以解释这些差异。
我们评估了目标群体的覆盖范围，以及关键干预组成部分（个体教育课程、结构化团队会议和风险评估）是否按计划实施（方案完成的最高得分为11分）。
最初的覆盖范围为91%，但只有少数患者按计划完成了干预活动。干预组成部分数量的平均得分较低（11分中得5.66分（标准差2.8）），且在各中心之间（4.84至7.40分）和不同种族群体之间（4.89至7.38分）存在差异，其中团队会议是最未按计划实施的活动。
本研究表明，在全科医疗中增加一名实习护士和一名同伴健康教育工作者似乎并未促成医护人员之间达成理想的协作。需要进一步研究以调查患者干预参与率低背后的原因。
