Faculty of Medicine & Health, The University of Sydney, New South Wales, Australia.
Centre of Excellence in Population Ageing Research, The University of Sydney, New South Wales, Australia.
Gerontologist. 2021 Aug 13;61(6):965-976. doi: 10.1093/geront/gnaa105.
The translation of reablement programs into practice is lagging despite strong evidence for interventions that maintain function for the person living with dementia as well as improve carer well-being. The aim was to evaluate the implementation of an evidence-based program, Care of People with Dementia in Their Environments (COPE), into health services.
An implementation-effectiveness hybrid design was used to evaluate implementation outcomes while simultaneously involving a pragmatic pre-post evaluation of outcomes for people with dementia. We report uptake, fidelity to intervention, outcomes for people living with dementia and carers, and beliefs and behaviors of interventionists contributing to successful implementation.
Seventeen organizations in Australia across 3 health contexts, 38 occupational therapists, and 17 nurses participated in training and implementation. While there were challenges and delays in implementation, most organizations were able to offer the program and utilized different models of funding. Overall, we found there was moderate fidelity to components of the program. Pre-post outcomes for carer well-being and coping (Perceived Change Index, p < .001) and activity engagement of the person living with dementia (p = .002) were significantly increased, replicating previous trial results. What contributed most to therapists implementing the program (Determinants of Implementation Behaviour Questionnaire) was a stronger intent to deliver (p < .001), higher confidence (p < .001), a sense of control in delivery (p = .004), and a belief the program was very useful to their clients (p = .002).
This study demonstrated that implementation is possible in multiple health systems and beneficial to individuals and their families.
尽管有大量证据表明干预措施可以维持痴呆症患者的功能并改善照顾者的幸福感，但再适应计划在实践中的实施情况却滞后不前。本研究旨在评估将循证方案“在环境中照顾痴呆症患者”（COPE）应用于卫生服务中的实施效果。
采用实施效果混合设计，同时对痴呆症患者的结果进行实用的前后评估，以评估实施结果。我们报告了参与培训和实施的接受情况、对干预措施的保真度、痴呆症患者和照顾者的结果，以及有助于成功实施的干预者的信念和行为。
澳大利亚 3 个卫生背景下的 17 个组织、38 名职业治疗师和 17 名护士参与了培训和实施。尽管实施过程中存在挑战和延迟，但大多数组织都能够提供该方案，并采用不同的资金模式。总体而言，我们发现该方案的组成部分具有中等保真度。照顾者幸福感和应对能力（感知变化指数，p <.001）以及痴呆症患者的活动参与度（p =.002）的前后结果显著增加，复制了先前试验的结果。对治疗师实施该方案贡献最大的因素（实施行为决定因素问卷）是更强的提供意愿（p <.001）、更高的信心（p <.001）、对提供的控制感（p =.004）以及对方案对客户非常有用的信念（p =.002）。
本研究表明，在多个卫生系统中实施是可行的，对个人及其家庭都有益。
