Huntink E, Wensing M, Timmers I M, van Lieshout J
Department IQ healthcare, Radboud Institute of Health Sciences, Radboud university medical center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arkaden, Turm West, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
Implement Sci. 2016 Dec 15;11(1):164. doi: 10.1186/s13012-016-0526-z.
A tailored implementation programme to improve cardiovascular risk management (CVRM) in general practice had little impact on outcomes. The questions in this process evaluation concerned (1) impact on counselling skills and CVRM knowledge of practice nurses, (2) their use of the various components of the intervention programme and adoption of recommended practices and (3) patients' perceptions of counselling for CVRM.
A mixed-methods process evaluation was conducted. We assessed practice nurses' motivational interviewing skills on audio-taped consultations using Motivational Interviewing Treatment Integrity (MITI). They also completed a clinical knowledge test. Both practice nurses and patients reported on their experiences in a written questionnaire and interviews. A multilevel regression analysis and an independent sample t test were used to examine motivational interviewing skills and CVRM knowledge. Framework analysis was applied to analyse qualitative data.
Data from 34 general practices were available, 19 intervention practices and 14 control practices. No improvements were measured on motivational interviewing skills in both groups. There appeared to be better knowledge of CVRM in the control group. On average half of the practice nurses indicated that they adopted the recommended interventions, but stated that they did not necessarily record this in patients' medical files. The tailored programme was perceived as too large. Time, follow-up support and reminders were felt to be lacking. About 20% of patients in the intervention group visited the general practice during the intervention period, yet only a small number of these patients were referred to recommended options.
The tailored programme was only partly used by practice nurses and had little impact on either their clinical knowledge and communication skills or on patient reported healthcare. If the assumed logical model of change is valid, a more intensive programme is needed to have an impact on CVRM in general practice at all.
一项旨在改善全科医疗中心血管疾病风险管理（CVRM）的定制实施计划对结果影响甚微。本过程评估中的问题涉及：（1）对执业护士咨询技能和CVRM知识的影响；（2）他们对干预计划各组成部分的使用情况以及对推荐做法的采用情况；（3）患者对CVRM咨询的看法。
进行了一项混合方法的过程评估。我们使用动机性访谈治疗完整性（MITI）对录音咨询中的执业护士动机性访谈技能进行评估。他们还完成了一项临床知识测试。执业护士和患者都通过书面问卷和访谈报告了他们的经历。使用多水平回归分析和独立样本t检验来检验动机性访谈技能和CVRM知识。应用框架分析来分析定性数据。
有来自34个全科医疗中心的数据，其中19个为干预中心，14个为对照中心。两组的动机性访谈技能均未得到改善。对照组对CVRM的了解似乎更好。平均而言，一半的执业护士表示他们采用了推荐的干预措施，但表示不一定会将其记录在患者的病历中。定制计划被认为规模太大。感觉缺乏时间、后续支持和提醒。干预组中约20%的患者在干预期内就诊于全科医疗中心，但这些患者中只有少数被转介至推荐的选项。
执业护士仅部分使用了定制计划，该计划对他们的临床知识和沟通技能以及患者报告的医疗保健几乎没有影响。如果假定的逻辑变革模型是有效的，那么需要一个更强化的计划才能对全科医疗中的CVRM产生影响。
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