Department of Social Policy and Department of Management, London School of Economics and Political Science, Houghton Street, London, WC2A 2A, UK.
Centre for Applied Dementia Studies, Faculty of Health Studies, Richmond Road, Bradford, BD7 1DP, UK.
BMC Health Serv Res. 2020 Jul 15;20(1):657. doi: 10.1186/s12913-020-05416-x.
Provision of care and support for people with dementia and family carers is complex, given variation in how dementia manifests, progresses and affects people, co-morbidities associated with ageing, as well as individual preferences, needs, and circumstances. The traditional service-led approach, where individual needs are assessed against current service provision, has been recognised as unfit to meet such complexity. As a result, people with dementia and family members often fail to receive adequate support, with needs remaining unmet. Current research lacks a conceptual framework for explaining variation in satisfaction of care needs. This work develops a conceptual framework mapped onto the care delivery process to explain variations in whether, when and why care needs of people with dementia are met and to expose individual-, service-, system-level factors that enable or hinder needs satisfaction.
Data collected through 24 in-depth interviews and two focus groups (10 participants) with people with dementia and family carers living in the North East of England (UK) were analysed thematically to develop a typology of care needs. The need most frequently reported for people with dementia (i.e. for support to go out and about) was analysed using themes stemming from the conceptual framework which combined candidacy and discrepancy theories.
The operationalisation of the framework showed that satisfaction of the need to go out was first determined at the point of service access, affected by issues about navigation, adjudication, permeability, users' resistance to offers, users' appearance, and systems-level operating conditions, and, subsequently, at the point of service use, when factors related to service structure and care process determined (dis)satisfaction with service and, hence, further contributed to met or unmet need.
The conceptual framework pinpoints causes of variations in satisfaction of care needs which can be addressed when designing interventions and service improvements.
由于痴呆的表现、进展和影响因人而异，与衰老相关的合并症也各不相同，加上个人偏好、需求和情况的差异，为痴呆患者及其家庭照顾者提供护理和支持非常复杂。传统的以服务为导向的方法是根据当前的服务提供情况评估个人需求，这种方法已被认为无法满足这种复杂性。因此，痴呆患者和家庭成员往往无法获得足够的支持，需求得不到满足。目前的研究缺乏一个解释护理需求满足差异的概念框架。这项工作开发了一个概念框架，该框架映射到护理提供过程中，以解释痴呆患者的护理需求是否得到满足、何时得到满足以及为何得到满足的差异，并揭示能够促进或阻碍需求满足的个体、服务、系统层面的因素。
通过对居住在英格兰东北部（英国）的痴呆患者及其家庭照顾者进行的 24 次深度访谈和两次焦点小组（共 10 名参与者）收集的数据进行主题分析，以制定一种护理需求分类法。对痴呆患者最常报告的需求（即外出支持）进行分析时，使用了源自该概念框架的主题，该框架结合了候选理论和差异理论。
该框架的实施表明，外出需求的满足首先在服务准入点确定，受导航、裁决、渗透性、用户对服务的抗拒、用户的外貌以及系统级运营条件等问题的影响，随后在服务使用点确定，此时与服务结构和护理过程相关的因素决定了对服务的（不）满意程度，从而进一步导致需求的满足或未满足。
该概念框架指出了导致护理需求满足差异的原因，在设计干预措施和服务改进时可以针对这些原因进行处理。
