老年医学专家对围手术期护理的观点：一项定性研究。
Geriatrician perspectives on perioperative care: a qualitative study.
机构信息
Department of Geriatric Medicine, Concord Hospital, Sydney, Australia.
Concord Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
出版信息
BMC Geriatr. 2021 Jan 19;21(1):68. doi: 10.1186/s12877-021-02019-x.
BACKGROUND
Perioperative medicine services for older surgical patients are being developed across several countries. This qualitative study aims to explore geriatricians' perspectives on challenges and opportunities for developing and delivering integrated geriatrics perioperative medicine services.
METHODS
A qualitative phenomenological semi-structured interview design. All geriatric medicine departments in acute public hospitals across Australia and New Zealand (n = 81) were approached. Interviews were conducted with 38 geriatricians. Data were analysed thematically using a framework approach.
RESULTS
Geriatricians identified several system level barriers to developing geriatrics perioperative medicine services. These included lack of funding for staffing, encroaching on existing consultative services, and competing clinical priorities. The key barrier at the healthcare professional level was the current lack of clarity of roles within the perioperative care team. Key facilitators were perceived unmet patient needs, existing support for geriatrician involvement from surgical and anaesthetic colleagues, and the unique skills geriatricians can bring to perioperative care. Despite reporting barriers, geriatricians are contemplating and implementing integrated proactive perioperative medicine services. Geriatricians identified a need to support other specialties gain clinical experience in geriatric medicine and called for pragmatic research to inform service development.
CONCLUSIONS
Geriatricians perceive several challenges at the system and healthcare professional levels that are impacting current development of geriatrics perioperative medicine services. Yet their strong belief that patient needs can be met with their specialty skills and their high regard for team-based care, has created opportunities to implement innovative multidisciplinary models of care for older surgical patients. The barriers and evidence gaps highlighted in this study may be addressed by qualitative and implementation science research. Future work in this area may include application of patient-reported measures and qualitative research with patients to inform patient-centred perioperative care.
背景
许多国家都在为老年手术患者提供围手术期医学服务。本定性研究旨在探讨老年医学专家对开发和提供综合老年围手术期医学服务所面临的挑战和机遇的看法。
方法
采用定性现象学半结构式访谈设计。对澳大利亚和新西兰所有急性公立医院的老年医学科（n=81）进行了调查。对 38 名老年医学专家进行了访谈。采用框架方法对数据进行主题分析。
结果
老年医学专家确定了一些在开发老年围手术期医学服务方面的系统层面障碍。这些障碍包括为人员配备提供资金不足、侵犯现有咨询服务以及竞争激烈的临床重点。在医疗保健专业人员层面的主要障碍是围手术期护理团队中当前角色不明确。主要促进因素是认为存在未满足的患者需求、外科和麻醉科同事对老年医学专家参与的现有支持，以及老年医学专家可以为围手术期护理带来的独特技能。尽管报告存在障碍，但老年医学专家正在考虑并实施综合的主动围手术期医学服务。老年医学专家认为有必要支持其他专业获得老年医学临床经验，并呼吁开展务实的研究以提供服务开发的信息。
结论
老年医学专家认为，系统和医疗保健专业人员层面存在若干挑战，这对当前老年围手术期医学服务的发展产生了影响。然而，他们坚信患者的需求可以通过他们的专业技能和他们对团队为基础的护理的高度重视来满足，这为为老年手术患者实施创新的多学科护理模式创造了机会。本研究中强调的障碍和证据差距可以通过定性和实施科学研究来解决。未来在这一领域的工作可能包括应用患者报告的措施和对患者进行定性研究，以提供以患者为中心的围手术期护理。
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