Cleland Jennifer, Moffat Mandy, Small Iain
Department of General Practice, Foresterhill Health Centre, Aberdeen, UK.
Prim Care Respir J. 2012 Sep;21(3):255-60. doi: 10.4104/pcrj.2012.00008.
The need to consider anticipatory preventive care for people with chronic obstructive pulmonary disease (COPD) has been highlighted in UK guidelines and policy.
To explore stakeholder views of the utility and design of a community-based anticipatory care service (CBACS) for COPD.
This was a qualitative study using focus groups and in-depth interviews in North-East Scotland. Key stakeholders were purposively sampled: GPs (n=7), practice nurses (n=6), community nurses (n=4), district nurses (n=6), physiotherapists (n=6), pharmacists (n=8), COPD Managed Clinical Network members (n=8), NHS managers (n=4), the COPD Early Supported Discharge (ESD) Team (n=7), patients and carers (n=7). Data were analysed using framework analysis.
A CBACS for COPD was broadly acceptable to most participants although not all wished direct involvement. Patient education and empowerment, clear roles, effective communication across traditional service boundaries, generic and clinical skills training, ongoing support and a holistic service were seen as crucial. Potential issues included: resources; anticipatory care being in conflict with the 'reactive' ethos of NHS care; and the breadth of clinical knowledge required.
A CBACS for COPD requires additional resources and professionals will need to adapt to a new model of service delivery for which they may not be ready.
英国的指南和政策强调了对慢性阻塞性肺疾病（COPD）患者进行预期性预防护理的必要性。
探讨利益相关者对COPD社区预期护理服务（CBACS）的效用和设计的看法。
这是一项在苏格兰东北部进行的定性研究，采用焦点小组和深入访谈的方法。关键利益相关者通过目的抽样选取：全科医生（n = 7）、执业护士（n = 6）、社区护士（n = 4）、 district护士（n = 6）、物理治疗师（n = 6）、药剂师（n = 8）、COPD管理临床网络成员（n = 8）、NHS管理人员（n = 4）、COPD早期支持出院（ESD）团队（n = 7）、患者及其护理人员（n = 7）。数据采用框架分析法进行分析。
大多数参与者对COPD的CBACS基本接受，尽管并非所有人都希望直接参与。患者教育与赋权、明确的角色、跨越传统服务界限的有效沟通、通用和临床技能培训、持续支持以及整体服务被视为至关重要。潜在问题包括：资源；预期护理与NHS护理的“反应性”理念相冲突；以及所需临床知识的广度。
COPD的CBACS需要额外的资源，专业人员需要适应一种他们可能尚未准备好的新服务提供模式。
