Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
The Walton Centre NHS Foundation Trust, Liverpool, UK.
BMJ Open. 2018 Sep 28;8(9):e021246. doi: 10.1136/bmjopen-2017-021246.
To establish the appropriateness of a previously developed seizure care pathway by exploring to what extent patients valued the intervention and perceived it as being helpful or not.
Qualitative descriptive study, using semistructured, in-depth interviews and thematic template analysis, theoretically informed by critical realism.
In North West England, a seizure care pathway has been developed in collaboration with a specialist neurology hospital to support clinical management of seizure patients on initial presentation to the emergency department (ED), as well as access to follow-up services on discharge, with the aim of improving patient experience. Three National Health Service (NHS) EDs and a specialist neurology hospital provided the setting for participant recruitment to this study.
181 patients fulfilled the inclusion criterion with 27 participants taking part following their experience of an ED attendance and outpatient follow-up appointment after a seizure.
Five main themes emerged from the data: decision to seek care, responsiveness of services, waiting and efficiency, information and support, and care continuity. Two integrative themes spanned the whole study: lived experience and communication. This paper reports on two of the main themes: care continuity, and waiting and efficiency. The average time between ED presentation and interview completion was 100 days.
Implementation of a care pathway is a complex intervention, requiring long-term follow-up to assess its integration into practice and effectiveness in service improvement. The seizure care pathway has the potential to enhance the care of seizure patients in the ED and at follow-up by improving continuity and management of care. The study demonstrates good aspects of the seizure care pathway as observed by patients and also recognises shortcomings within current service provision and questions what the NHS should and should not be delivering. Our study suggests various ways to enhance the pathway at service level to potentially drive improved patient experience.
通过探索患者对干预措施的重视程度以及对干预措施的帮助程度，确定之前开发的癫痫护理路径的适宜性。
定性描述性研究，采用半结构化深入访谈和主题模板分析，理论上受批判现实主义的启发。
在英格兰西北部，与一家专门的神经病学医院合作开发了癫痫护理路径，以支持癫痫患者在首次就诊于急诊部（ED）时的临床管理，以及在出院后获得后续服务，旨在改善患者体验。三家国民保健服务（NHS）ED 和一家专门的神经病学医院为这项研究的参与者招募提供了环境。
181 名患者符合纳入标准，其中 27 名患者在 ED 就诊后经历了门诊随访预约后参加了本研究。
从数据中出现了五个主要主题：寻求护理的决定、服务的响应性、等待和效率、信息和支持以及护理连续性。两个综合主题贯穿整个研究：生活体验和沟通。本文报告了两个主要主题：护理连续性和等待和效率。ED 就诊和访谈完成之间的平均时间为 100 天。
护理路径的实施是一项复杂的干预措施，需要进行长期随访，以评估其在实践中的整合情况以及在改善服务方面的效果。癫痫护理路径有可能通过改善 ED 和随访期间的护理连续性和管理来提高癫痫患者的护理质量。该研究展示了患者观察到的癫痫护理路径的良好方面，同时也认识到当前服务提供中的不足之处，并质疑 NHS 应该提供什么以及不应该提供什么。我们的研究提出了在服务层面上增强该路径的各种方法，以潜在地推动改善患者体验。
