Ettema Roelof, Schuurmans Marieke J, Schutijser Bernadette, van Baar Mark, Kamphof Nicole, Kalkman Cor J
Faculty of Health Care, University of Applied Science Utrecht, The Netherlands University Medical Centre Utrecht, The Netherlands
Faculty of Health Care, University of Applied Science Utrecht, The Netherlands University Medical Centre Utrecht, The Netherlands.
Eur J Cardiovasc Nurs. 2015 Aug;14(4):342-51. doi: 10.1177/1474515114535511. Epub 2014 May 12.
Given the growing number of vulnerable, older cardiac surgery patients, the preadmission PREvention Decline in Older Cardiac Surgery patients (PREDOCS) programme was developed to reduce the incidence of postoperative complications. Before the clinical effects of such a complex multicomponent intervention can be evaluated, the feasibility needs to be determined to detect possible problems with the acceptability, compliance and delivery.
The purpose of this study was to test the PREDOCS programme on its feasibility and estimate theoretical cost savings.
In a mixed-methods multicentre study, the Medical Research Council (MRC) guidelines concerning testing feasibility were followed, and theoretical cost savings were calculated. We used data from interviews and the continuous data registry at three hospitals. The results were reported following the criteria for reporting the feasibility of complex interventions (CReDECI).
Twenty-one females and 49 males out of 114 eligible patients completed the intervention and provided full data. Patients were equally satisfied with the usual care and the PREDOCS programme (satisfaction rate respectively standard deviation (SD): 7.5 (95% confidence interval (CI): 6.4-8.7) and 7.6 (6.6-8.6)). The involved nurses were satisfied with the tools for guiding patients to reduce their risk of postoperative complications and considered the PREDOCS programme as complementary to usual care. Integrating PREDOCS into current hospital structures appeared to be difficult. Both patients and nurses indicated that the additional consult was tiresome for the patient. The PREDOCS programme will be cost-effective when postoperative complications are prevented in six to sixteen of 1000 cardiac surgery patients.
The PREDOCS programme is acceptable for patients and nurses but should be built into the hospital's cardiac surgery pathway or applied in home care.
鉴于脆弱的老年心脏手术患者数量不断增加，为降低术后并发症的发生率，制定了术前预防老年心脏手术患者病情恶化（PREDOCS）计划。在评估这种复杂的多成分干预措施的临床效果之前，需要确定其可行性，以发现可接受性、依从性和实施方面可能存在的问题。
本研究旨在测试PREDOCS计划的可行性，并估计理论上的成本节约。
在一项混合方法的多中心研究中，遵循了医学研究委员会（MRC）关于测试可行性的指南，并计算了理论上的成本节约。我们使用了来自三家医院的访谈数据和连续数据登记册。结果按照报告复杂干预措施可行性的标准（CReDECI）进行报告。
114名符合条件的患者中，21名女性和49名男性完成了干预并提供了完整数据。患者对常规护理和PREDOCS计划的满意度相同（满意度评分分别为标准差（SD）：7.5（95%置信区间（CI）：6.4 - 8.7）和7.6（6.6 - 8.6））。参与的护士对指导患者降低术后并发症风险的工具感到满意，并认为PREDOCS计划是对常规护理的补充。将PREDOCS整合到当前医院结构中似乎很困难。患者和护士都表示，额外的咨询对患者来说很麻烦。当1000名心脏手术患者中有6至16名患者预防了术后并发症时，PREDOCS计划将具有成本效益。
PREDOCS计划对患者和护士来说是可接受的，但应纳入医院的心脏手术流程或应用于家庭护理。
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