Thrombosis Expert Centre Maastricht and Laboratory for Clinical Thrombosis and Haemostasis, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
PLoS One. 2022 Aug 8;17(8):e0272566. doi: 10.1371/journal.pone.0272566. eCollection 2022.
Although compression therapy is well established for patients with deep venous thrombosis (DVT) and chronic venous disease (CVD), considerable variation exists in its organization in clinical practice which may impact patient outcomes. The current study aims to deepen our understanding of the main drivers of the complex care organization for compression therapy and to identify targets for improvement.
This realist evaluation includes a mixed-method design consisting of semi-structured interviews with patients and health care professionals involved in compression therapy (n = 30), stakeholder meetings (n = 2) and surveys (n = 114). Data were collected to create the content of context-mechanism-outcome-configurations (CMOcs) important in compression therapy. Based on these CMOcs, targets for improvement to optimize the organization of compression care were identified.
We identified overarching context factors and mechanisms targeting four optimal outcomes for the organization of compression therapy: selecting initial compression therapy types that support patient's self-reliance (1), evidence based selection of elastic compression stocking type and class (2), patient-based selection of assistive devices (3), individualizing treatment duration for DVT patients (4a) and providing follow-up for CVD patients (4b). We found that increasing health care professionals' knowledge of compression therapy, the availability of unambiguous protocols and guidelines, increasing patient involvement (and if applicable their informal care giver) in the decision making process, the accessible availability of resources, and increasing interdisciplinary consultation enhanced desirable outcomes. These targets triggered mechanisms such as increased health care professionals' willingness, confidence and motivation to provide patient-based care and increased patients' self-confidence and self-efficacy.
This study provides a detailed insight into what needs to be in place to optimize compression care and identified five main targets for improvement.
尽管压缩疗法在深静脉血栓形成（DVT）和慢性静脉疾病（CVD）患者中得到了很好的应用，但在临床实践中，其组织形式存在很大差异，这可能会影响患者的治疗效果。本研究旨在深入了解压缩治疗复杂护理组织的主要驱动因素，并确定改进的目标。
本真实评估采用混合方法设计，包括对参与压缩治疗的患者和医疗保健专业人员（n=30）进行半结构式访谈、利益相关者会议（n=2）和调查（n=114）。收集数据以创建对压缩治疗有重要意义的背景-机制-结果-配置（CMOcs）的内容。基于这些 CMOcs，确定了优化压缩治疗组织的改进目标。
我们确定了总体背景因素和机制，针对压缩治疗组织的四个最佳结果：选择支持患者自理的初始压缩治疗类型（1）、基于证据选择弹性压缩袜类型和等级（2）、基于患者选择辅助设备（3）、个体化 DVT 患者的治疗持续时间（4a）和为 CVD 患者提供随访（4b）。我们发现，增加医疗保健专业人员对压缩治疗的了解、提供明确的方案和指南、增加患者（如果适用，还有他们的非正式照顾者）在决策过程中的参与度、增加资源的可及性以及增加跨学科咨询，都可以增强理想的治疗效果。这些目标触发了一些机制，例如增加医疗保健专业人员提供基于患者的护理的意愿、信心和动力，以及增加患者的自信和自我效能感。
本研究深入了解了优化压缩治疗需要具备的条件，并确定了五个主要的改进目标。
