Froggatt Katherine, Payne Sheila, Morbey Hazel, Edwards Michaela, Finne-Soveri Harriet, Gambassi Giovanni, Pasman H Roeline, Szczerbińska Katarzyna, Van den Block Lieve
International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
International Observatory on End of Life Care, Lancaster University, Lancaster, United Kingdom.
J Am Med Dir Assoc. 2017 Jun 1;18(6):550.e7-550.e14. doi: 10.1016/j.jamda.2017.02.016. Epub 2017 Apr 12.
The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting.
To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe.
We undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed.
We identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level.
Implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high-quality palliative care in care homes is supported by implementation activity at these 3 levels. Understanding where each country is in terms of activity at these 3 levels (macro, meso, and micro) will allow strategic focus on future implementation work in each country.
欧洲各国为老年人提供的机构长期护理存在差异，这反映了不同的医疗保健提供模式。对临终居民的护理需要将姑息治疗融入当前的护理工作中，但国际上对于在养老院环境中实施姑息治疗的不同方式了解甚少。
使用一种新的类型学，识别并分类欧洲各地养老院中与姑息治疗实施相关的各种不同的战略、运营和组织活动。
我们在29个欧洲国家开展了一项映射研究，采用两种数据收集方法：（1）对各国信息提供者进行调查，（2）查阅公开的二手数据源和已发表研究的数据。通过对调查数据进行描述性和主题分析，我们确定了在不同结构层面促进养老院姑息治疗发展和实施的因素。根据这些数据，制定了养老院部门姑息治疗实施的类型学，并应用于所调查的国家。
我们确定了养老院姑息治疗实施的三个层面：宏观（国家/地区政策、立法、财务和监管驱动因素）、中观（实施活动，如教育、工具/框架、服务模式和研究）和微观（姑息治疗服务提供）。这种类型学应用于从29个欧洲国家收集的数据，展示了欧洲各地在姑息治疗实施活动在范围、发展类型和提供方式方面的多样性。我们发现，两个层面的宏观和中观因素塑造了微观组织层面养老院中姑息治疗的实施和提供。
中观和微观层面的实施得到宏观层面参与的支持，但在宏观战略驱动因素有限的情况下也可能发生。这三个层面的实施活动有助于确保在养老院提供一致且高质量的姑息治疗。了解每个国家在这三个层面（宏观、中观和微观）的活动情况，将有助于在战略上聚焦每个国家未来的实施工作。
