den Herder-van der Eerden Marlieke, Ewert Benjamin, Hodiamont Farina, Hesse Michaela, Hasselaar Jeroen, Radbruch Lukas
Department of Anaesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands.
Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
J Integr Care (Brighton). 2017;25(3):222-232. doi: 10.1108/JICA-03-2017-0006.
Literature suggests that integrated palliative care (IPC) increases the quality of care for palliative patients at lower costs. However, knowledge on models encompassing all integration levels for successfully implementing IPC is scarce. The purpose of this paper is to describe the experiences of IPC leaders in seven European countries regarding core elements, facilitators and barriers of IPC implementation and provides recommendations for future policy and practice.
DESIGN/METHODOLOGY/APPROACH: A qualitative interview study was conducted between December 2013 and May 2014. In total, 34 IPC leaders in primary and secondary palliative care or public health in Belgium, Germany, Hungary, Ireland, the Netherlands, Spain and the UK were interviewed. Transcripts were analysed using thematic data analysis.
IPC implementation efforts involved a multidisciplinary team approach and cross-sectional coordination. Informal professional relationships, basic medical education and general awareness were regarded as facilitators of IPC. Identified barriers included lack of knowledge about when to start palliative care, lack of collaboration and financial structures. Recommendations for improvement included access, patient-centeredness, coordination and cooperation, financing and ICT systems.
ORIGINALITY/VALUE: Although IPC is becoming more common, action has been uneven at different levels. IPC implementation largely remains provisional and informal due to the lack of standardised treatment pathways, legal frameworks and financial incentives to support multilevel integration. In order to make IPC more accessible, palliative care education as well as legal and financial support within national healthcare systems needs to be enhanced.
文献表明，综合姑息治疗（IPC）能以更低成本提高姑息治疗患者的护理质量。然而，关于成功实施IPC的涵盖所有整合层面的模式的知识却很匮乏。本文旨在描述七个欧洲国家的IPC领导者在IPC实施的核心要素、促进因素和障碍方面的经验，并为未来的政策和实践提供建议。
设计/方法/途径：2013年12月至2014年5月进行了一项定性访谈研究。总共采访了比利时、德国、匈牙利、爱尔兰、荷兰、西班牙和英国的34名初级和二级姑息治疗或公共卫生领域的IPC领导者。使用主题数据分析对访谈记录进行了分析。
IPC的实施工作涉及多学科团队方法和横向协调。非正式的专业关系、基础医学教育和公众意识被视为IPC的促进因素。已确定的障碍包括对何时开始姑息治疗缺乏了解、缺乏合作和财务结构。改进建议包括可及性、以患者为中心、协调与合作、融资和信息通信技术系统。
原创性/价值：尽管IPC越来越普遍，但不同层面的行动并不均衡。由于缺乏标准化的治疗途径、法律框架和支持多层次整合的财务激励措施，IPC的实施在很大程度上仍处于临时和非正式状态。为了使IPC更容易获得，需要加强国家医疗保健系统内的姑息治疗教育以及法律和财政支持。
