Lourida Ilianna, Abbott Rebecca A, Rogers Morwenna, Lang Iain A, Stein Ken, Kent Bridie, Thompson Coon Jo
NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, University of Exeter, South Cloisters, St Luke's Campus, Exeter, EX1 2LU, UK.
School of Nursing and Midwifery, Plymouth University, Plymouth, UK.
BMC Geriatr. 2017 Jul 14;17(1):147. doi: 10.1186/s12877-017-0528-y.
The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.
We sought studies that addressed dissemination and implementation strategies or described barriers and facilitators to implementation across dementia stages and care settings. Twelve databases were searched from inception to October 2015 followed by forward citation and grey literature searches. Quantitative studies with a comparative research design and qualitative studies with recognised methods of data collection were included. Titles, abstracts and full texts were screened independently by two reviewers with discrepancies resolved by a third where necessary. Data extraction was performed by one reviewer and checked by a second. Strategies were mapped according to the ERIC compilation.
Eighty-eight studies were included (30 quantitative, 34 qualitative and 24 mixed-methods studies). Approximately 60% of studies reported implementation strategies to improve practice: training and education of professionals (94%), promotion of stakeholder interrelationships (69%) and evaluative strategies (46%) were common; financial strategies were rare (15%). Nearly 70% of studies reported barriers or facilitators of care practices primarily within residential care settings. Organisational factors, including time constraints and increased workload, were recurrent barriers, whereas leadership and managerial support were often reported to promote implementation. Less is known about implementation activities in primary care and hospital settings, or the views and experiences of people with dementia and their family caregivers.
This scoping review and mapping of the evidence reveals a paucity of robust evidence to inform the successful dissemination and implementation of evidence-based dementia care. Further exploration of the most appropriate methods to evaluate and report initiatives to bring about change and of the effectiveness of implementation strategies is necessary if we are to make changes in practice that improve dementia care.
在多个确定优先事项的合作项目中，人们已经认识到有必要更好地理解如何实施循证痴呆护理。本范围综述的目的是概述痴呆护理实施与传播的证据现状，并创建一个系统的证据图谱。
我们寻找涉及传播与实施策略或描述痴呆各阶段及护理环境中实施障碍与促进因素的研究。从数据库建立至2015年10月检索了12个数据库，随后进行了向前引文检索和灰色文献检索。纳入具有比较研究设计的定量研究以及采用公认数据收集方法的定性研究。两名评审员独立筛选标题、摘要和全文，如有分歧则由第三名评审员解决。数据提取由一名评审员进行，另一名评审员进行核对。根据教育资源信息中心（ERIC）汇编对策略进行映射。
纳入88项研究（30项定量研究、34项定性研究和24项混合方法研究）。约60%的研究报告了改善实践的实施策略：专业人员培训与教育（94%）、促进利益相关者的相互关系（69%）和评估策略（46%）较为常见；财务策略较少见（15%）。近70%的研究报告了护理实践的障碍或促进因素，主要存在于机构护理环境中。组织因素，包括时间限制和工作量增加，是反复出现的障碍，而领导和管理支持通常被报告为促进实施的因素。对于初级保健和医院环境中的实施活动，以及痴呆患者及其家庭护理人员的观点和经历了解较少。
本范围综述和证据图谱显示，缺乏有力证据为循证痴呆护理的成功传播与实施提供参考。如果我们要在实践中做出改善痴呆护理的改变，就有必要进一步探索评估和报告带来变革的举措的最合适方法，以及实施策略的有效性。
