儿科哮喘护理中患者报告的结局指标：运用理论领域框架探索医疗服务提供者的认知
Patient-reported outcome measures in pediatric asthma care: using theoretical domains framework to explore healthcare providers' perceptions.
作者信息
Bele Sumedh, Rabi Sarah, Zhang Muning, Oddone Paolucci Elizabeth, Johnson David W, Quan Hude, Santana Maria J
机构信息
Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada.
出版信息
J Patient Rep Outcomes. 2022 Aug 19;6(1):88. doi: 10.1186/s41687-022-00494-3.
BACKGROUND
Patient-reported outcome measures (PROMs) play an important role in promoting and supporting patient and family-centered care. Implementing interventions like PROMs in routine clinical care require key stakeholders to change their behavior. The aim of this study was to utilize the Theoretical Domains Framework (TDF) to identify barriers and enablers to the implementation of PROMs in pediatric outpatient asthma clinics from healthcare providers' perspective.
METHODS
This TDF-guided qualitative descriptive study is part of a larger multi-phase project to develop the KidsPRO program, an electronic platform to administer, collect, and use PROMs in pediatrics. Semi-structured qualitative interviews were conducted with 17 participants, which included pediatricians, nurses, allied health professionals and administrative staff from outpatient asthma clinics. All the interviews were transcribed, deductively coded, inductively grouped in themes, and categorized into barriers and enablers.
RESULTS
We identified 33 themes within 14 TDF domains, which were further categorized and tabulated into 16 barriers and 17 enablers to implementing PROMs in asthma clinics. Barriers to behavioral change were attributed to personal, clinical, non-clinical, and other system-level factors; they ranged from limited awareness of PROMs to language barriers and patient's complex family background. Enablers ranged from a personal commitment to providing patient and family-centered care to administering PROMs electronically.
CONCLUSION
This implementation of science-based systematic inquiry captured the complexity of PROMs implementation in pediatric outpatient clinical care for asthma. Considering the consistency in barriers and enablers to implementing PROMs across patient populations and care settings, many findings of this study will be directly applicable to other pediatric healthcare settings.
背景
患者报告结局测量（PROMs）在促进和支持以患者及家庭为中心的医疗护理中发挥着重要作用。在常规临床护理中实施如PROMs这样的干预措施需要关键利益相关者改变其行为。本研究的目的是从医疗服务提供者的角度，利用理论领域框架（TDF）来识别在儿科门诊哮喘诊所实施PROMs的障碍和促进因素。
方法
这项由TDF指导的定性描述性研究是一个更大的多阶段项目的一部分，该项目旨在开发KidsPRO项目，这是一个用于在儿科管理、收集和使用PROMs的电子平台。对17名参与者进行了半结构化定性访谈，这些参与者包括来自门诊哮喘诊所的儿科医生、护士、专职医疗人员和行政人员。所有访谈都进行了转录、演绎编码、归纳分组形成主题，并分类为障碍和促进因素。
结果
我们在14个TDF领域内识别出33个主题，这些主题进一步分类并列表为在哮喘诊所实施PROMs的16个障碍和17个促进因素。行为改变的障碍归因于个人、临床、非临床和其他系统层面的因素；范围从对PROMs的认识有限到语言障碍和患者复杂的家庭背景。促进因素包括从个人致力于提供以患者及家庭为中心的医疗护理到以电子方式管理PROMs。
结论
这种基于科学的系统探究的实施捕捉到了在儿科门诊哮喘临床护理中实施PROMs的复杂性。考虑到在不同患者群体和护理环境中实施PROMs的障碍和促进因素的一致性，本研究的许多发现将直接适用于其他儿科医疗环境。
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