Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, The University of Manchester, Manchester, UK
Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, University of Manchester, Manchester, UK.
BMJ Open. 2022 Jun 1;12(6):e054780. doi: 10.1136/bmjopen-2021-054780.
Identifying and managing the needs of frail people in the community is an increasing priority for policy makers. We sought to identify factors that enable or constrain the implementation of interventions for frail older persons in primary care.
A rapid realist review.
Cochrane Library, SCOPUS and EMBASE, and grey literature. The search was conducted in September 2019 and rerun on 8 January 2022.
We considered all types of empirical studies describing interventions targeting frailty in primary care.
We followed the Realist and Meta-narrative Evidence Syntheses: Evolving Standards quality and publication criteria for our synthesis to systematically analyse and synthesise the existing literature and to identify (intervention-context-mechanism-outcome) configurations. We used normalisation processes theory to illuminate mechanisms surrounding implementation.
Our primary research returned 1755 articles, narrowed down to 29 relevant frailty intervention studies conducted in primary care. Our review identified two families of interventions. They comprised: (1) interventions aimed at the comprehensive assessment and management of frailty needs; and (2) interventions targeting specific frailty needs. Key factors that facilitate or inhibit the translation of frailty interventions into practice related to the distribution of resources; patient engagement and professional skill sets to address identified need.
There remain challenges to achieving successful implementation of frailty interventions in primary care. There were a key learning points under each family. First, targeted allocation of resources to address specific needs allows a greater alignment of skill sets and reduces overassessment of frail individuals. Second, earlier patient involvement may also improve intervention implementation and adherence.
The published protocol for the review is registered with PROSPERO (CRD42019161193).
识别和满足社区中体弱人群的需求是政策制定者日益关注的重点。我们旨在确定能够促进或限制初级保健中体弱老年人干预措施实施的因素。
快速现实主义审查。
Cochrane 图书馆、SCOPUS 和 EMBASE 以及灰色文献。搜索于 2019 年 9 月进行，并于 2022 年 1 月 8 日重新进行。
我们考虑了所有类型的描述针对初级保健中衰弱干预措施的实证研究。
我们遵循现实主义和元叙事证据综合：不断发展的标准，对我们的综合进行质量和出版标准，以系统地分析和综合现有文献，并确定（干预-背景-机制-结果）配置。我们使用正常化过程理论来阐明实施周围的机制。
我们的主要研究返回了 1755 篇文章，缩小到 29 篇在初级保健中进行的相关衰弱干预研究。我们的综述确定了两类干预措施。它们包括：（1）旨在全面评估和管理衰弱需求的干预措施；（2）针对特定衰弱需求的干预措施。促进或抑制衰弱干预措施转化为实践的关键因素与资源分配有关；患者参与和专业技能以满足确定的需求。
在初级保健中实现衰弱干预措施的成功实施仍然存在挑战。每个家庭都有一个关键的学习点。首先，有针对性地分配资源以满足特定需求可以更好地调整技能组合，并减少对虚弱个体的过度评估。其次，更早地让患者参与也可能会改善干预措施的实施和依从性。
该综述的已发表方案已在 PROSPERO（CRD42019161193）上注册。
