Corry Dagmar Anna S, Carter Gillian, Doyle Frank, McGlade Kieran, O'Halloran Peter, Wallace Emma, Brazil Kevin
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.
Pilot Feasibility Stud. 2022 Jan 19;8(1):10. doi: 10.1186/s40814-022-00973-w.
Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. This study aimed to elicit the feedback of participating general practitioners, practice managers, nurses and an adjunct pharmacist on the implementation strengths and limitations of a nurse-led, person-centered anticipatory care planning (ACP) intervention for older people at risk of functional decline in a primary care setting. The findings have implications for a full trial and intervention design.
As part of a feasibility cluster randomized controlled trial (cRCT) testing the ACP intervention, we sought feedback from implementing stakeholders: general practitioners (N = 3), practice staff (N = 3), research nurses (N = 5), and adjunct pharmacist (N = 1) in both the Republic of Ireland (ROI) and Northern Ireland (NI), UK. Following written, informed consent, they were interviewed to investigate their experience of participating in the implementation of the ACP intervention as part of the feasibility trial, and elicit any recommendations for a full trial. Using the Consolidated Framework for Implementation Research, thematic analysis was employed to analyze data. The intervention consisted of home visits by specially trained nurses who assessed participants' health, discussed with them their health goals and plans, and devised an anticipatory care plan following consultation with participants' General Practitioners and the adjunct clinical pharmacist.
Participating stakeholders indicated that the strengths of the implementation process included the training provided to the nurses, constructive collaboration of the research team, and structure of implementation process. Perceived limitations included the selection process and screening tool, communication between the research team and the nurses, the assessment questionnaire, and the final document left with the patient, as well as lack of access to medical records for the adjunct pharmacist. Recommendations include better communication and team-wide consensus on alterations to procedure and documents, and standardized protocols for patient selection, data collection, and reporting for research nurses.
The findings have identified strengths of the implementation process on which to build, and recognized limitations which can now be addressed to ensure improved efficiency and effectiveness in future trials.
Clinicaltrials.gov , ID: NCT03902743. Registered on 4 April 2019.
在有效管理老年人群复杂的多种慢性病、预防功能进一步衰退以及避免住院方面，预瞻性护理正变得越来越重要。本研究旨在收集参与研究的全科医生、诊所管理人员、护士和一名兼职药剂师对一项由护士主导、以患者为中心的预瞻性护理计划（ACP）干预措施在基层医疗环境中对有功能衰退风险的老年人实施的优势和局限性的反馈。研究结果对全面试验和干预设计具有启示意义。
作为一项测试ACP干预措施的可行性整群随机对照试验（cRCT）的一部分，我们征求了爱尔兰共和国（ROI）和英国北爱尔兰（NI）的实施利益相关者的反馈：全科医生（N = 3）、诊所工作人员（N = 3）、研究护士（N = 5）和兼职药剂师（N = 1）。在获得书面知情同意后，对他们进行了访谈，以调查他们作为可行性试验的一部分参与ACP干预措施实施的经验，并征求对全面试验的任何建议。使用实施研究综合框架，采用主题分析法对数据进行分析。该干预措施包括由经过专门培训的护士进行家访，护士评估参与者的健康状况，与他们讨论健康目标和计划，并在与参与者的全科医生和兼职临床药剂师协商后制定预瞻性护理计划。
参与的利益相关者表示实施过程的优势包括为护士提供的培训、研究团队的建设性合作以及实施过程的结构。感知到的局限性包括选择过程和筛查工具、研究团队与护士之间的沟通、评估问卷以及留给患者的最终文件，以及兼职药剂师无法获取病历。建议包括就程序和文件更改进行更好的沟通和团队范围内的共识，以及为研究护士制定患者选择、数据收集和报告的标准化方案。
研究结果确定了实施过程中可资借鉴的优势，并认识到了现在可以解决的局限性，以确保未来试验的效率和效果得到提高。
Clinicaltrials.gov，ID：NCT03902743。于2019年4月4日注册。
