为慢性病患者量身定制循证实践的实施方法。
Tailored implementation of evidence-based practice for patients with chronic diseases.
作者信息
Wensing Michel, Huntink Elke, van Lieshout Jan, Godycki-Cwirko Maciek, Kowalczyk Anna, Jäger Cornelia, Steinhäuser Jost, Aakhus Eivind, Flottorp Signe, Eccles Martin, Baker Richard
机构信息
Radboud University Medical Centre, Nijmegen, The Netherlands.
Medical University of Lodz, Lodz, Poland.
出版信息
PLoS One. 2014 Jul 8;9(7):e101981. doi: 10.1371/journal.pone.0101981. eCollection 2014.
BACKGROUND
When designing interventions and policies to implement evidence based healthcare, tailoring strategies to the targeted individuals and organizations has been recommended. We aimed to gather insights into the ideas of a variety of people for implementing evidence-based practice for patients with chronic diseases, which were generated in five European countries.
METHODS
A qualitative study in five countries (Germany, Netherlands, Norway, Poland, United Kingdom) was done, involving overall 115 individuals. A purposeful sample of four categories of stakeholders (healthcare professionals, quality improvement officers, healthcare purchasers and authorities, and health researchers) was involved in group interviews in each of the countries to generate items for improving healthcare in different chronic conditions per country: chronic obstructive pulmonary disease, cardiovascular disease, depression in elderly people, multi-morbidity, obesity. A disease-specific standardized list of determinants of practice in these conditions provided the starting point for these groups. The content of the suggested items was categorized in a pre-defined framework of 7 domains and specific themes in the items were identified within each domain.
RESULTS
The 115 individuals involved in the study generated 812 items, of which 586 addressed determinants of practice. These largely mapped onto three domains: individual health professional factors, patient factors, and professional interactions. Few items addressed guideline factors, incentives and resources, capacity of organizational change, or social, political and legal factors. The relative numbers of items in the different domains were largely similar across stakeholder categories within each of the countries. The analysis identified 29 specific themes in the suggested items across countries.
CONCLUSION
The type of suggestions for improving healthcare practice was largely similar across different stakeholder groups, mainly addressing healthcare professionals, patient factors and professional interactions. As this study is one of the first of its kind, it is important that more research is done on tailored implementation strategies.
背景
在设计基于证据的医疗保健干预措施和政策时，建议针对目标个人和组织量身定制策略。我们旨在深入了解五个欧洲国家中各类人群对于为慢性病患者实施循证实践的想法。
方法
在五个国家（德国、荷兰、挪威、波兰、英国）开展了一项定性研究，共涉及115人。在每个国家，有目的地抽取四类利益相关者（医疗保健专业人员、质量改进官员、医疗保健购买者与当局以及健康研究人员）进行小组访谈，以生成针对各国不同慢性病（慢性阻塞性肺疾病、心血管疾病、老年人抑郁症、多种疾病并存、肥胖症）改善医疗保健的项目。这些疾病特定的实践决定因素标准化列表为这些小组提供了起点。所提项目的内容按照预先定义的7个领域框架进行分类，并在每个领域内确定项目中的具体主题。
结果
参与研究的115人共提出812个项目，其中586个涉及实践决定因素。这些项目主要归入三个领域：个体医疗保健专业人员因素、患者因素和专业互动。很少有项目涉及指南因素、激励措施与资源、组织变革能力或社会、政治和法律因素。在每个国家的不同利益相关者类别中，不同领域项目的相对数量大致相似。分析确定了各国所提项目中的29个具体主题。
结论
不同利益相关者群体对改善医疗保健实践的建议类型大致相似，主要涉及医疗保健专业人员、患者因素和专业互动。由于本研究是同类研究中的首批研究之一，因此对量身定制的实施策略开展更多研究很重要。
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