Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.
School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
BMC Health Serv Res. 2021 Aug 25;21(1):871. doi: 10.1186/s12913-021-06896-1.
Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting.
We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants' health, discussed their health goals and devised an anticipatory care plan following consultation with participants' GPs and adjunct clinical pharmacist. As part of the project, we elicited the views and recommendations of experienced key health professionals working with the target population who were recruited using a 'snowballing technique' in cooperation with older people health networks in the Republic of Ireland (ROI) and Northern Ireland (NI), United Kingdom [n = 16: 7 ROI, 9 NI]. Following receipt of written information about the intervention and the provision of informed consent, the health professionals were interviewed to determine their expert views on the feasibility of the ACP intervention and recommendations for successful implementation. Data were analyzed using thematic analysis.
The ACP intervention was perceived to be beneficial for most older patients with multimorbidity. Effective and sustainable implementation was said to be facilitated by accurate and timely patient selection, GP buy-in, use of existing structures within health systems, multidisciplinary and integrated working, ACP nurse training, as well as patient health literacy. Barriers emerged as significant work already undertaken, increasing workload, lack of time, funding and resources, fragmented services, and geographical inequalities.
The key health professionals perceived the ACP intervention to be highly beneficial to patients, with significant potential to prevent or avoid functional decline and hospital admissions. They suggested that successful implementation of this primary care based, whole-person approach would involve integrated and multi-disciplinary working, GP buy in, patient health education, and ACP nurse training. The findings have potential implications for a full trial, and patient care and health policy.
Clinicaltrials.gov, ID: NCT03902743 . Registered on 4 April 2019.
人口老龄化给国际卫生系统带来了挑战，因为需要为功能衰退的老年患者提供更加复杂的护理。本研究旨在征求主要卫生专业人员的意见，了解他们对在初级保健环境中实施以护士为主导、以患者为中心的预期性护理计划（ACP）干预措施的有效性和可持续性的看法，以帮助有功能衰退风险的老年患者。
我们在一项跨越司法管辖区的可行性集群随机对照试验中检验了 ACP 干预措施的可行性，该试验包括研究护士的家访，研究护士根据参与者的健康状况进行评估，与参与者的全科医生和附加临床药剂师协商后，讨论他们的健康目标并制定预期性护理计划。作为该项目的一部分，我们征求了与目标人群合作的经验丰富的主要卫生专业人员的意见和建议，这些专业人员是通过与爱尔兰共和国（ROI）和北爱尔兰（NI）、英国的老年人健康网络合作，使用“滚雪球”技术招募的[共 16 人：7 人来自 ROI，9 人来自 NI]。在收到有关干预措施的书面信息并提供知情同意后，对卫生专业人员进行了访谈，以确定他们对 ACP 干预措施的可行性的专家意见和成功实施的建议。使用主题分析对数据进行了分析。
ACP 干预措施被认为对大多数患有多种疾病的老年患者有益。准确及时的患者选择、全科医生的认同、利用卫生系统内现有的结构、多学科和整合工作、ACP 护士培训以及患者健康素养被认为有助于干预措施的有效和可持续实施。出现的障碍包括已经开展的大量工作、工作量增加、缺乏时间、资金和资源、服务碎片化以及地理不平等。
主要卫生专业人员认为 ACP 干预措施对患者非常有益，具有显著预防或避免功能衰退和住院的潜力。他们建议，这种以初级保健为基础、全面的方法的成功实施将涉及整合和多学科工作、全科医生的认同、患者健康教育和 ACP 护士培训。研究结果对全面试验以及患者护理和卫生政策具有潜在影响。
Clinicaltrials.gov，ID：NCT03902743。于 2019 年 4 月 4 日注册。
