State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Taipa, Macao SAR, China.
Department of Public Health and Medicinal Administration, Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China.
Front Public Health. 2022 Sep 29;10:950704. doi: 10.3389/fpubh.2022.950704. eCollection 2022.
The "Specialist Medical Outreach Project (SMOP)" involving inter-disciplinary hospital-based healthcare professionals is a government initiative that aims to provide integrative specialist care to high-risk residents at the nursing homes. However, research exploring the implementation and impact of SMOP is lacking. This study aimed to evidence the impact of SMOP on the quality of care at the nursing home and the key contextual determinants influencing SMOP outcomes.
Semi-structured key informant audio-recorded face-to-face interviews were conducted with eight managers, six doctors, 28 nursing staff, and seven pharmacy staff at the nursing homes participating in the SMOP to collect insights about how SMOP was operated and performed, and the impact of SMOP as observed and expected. Participants were recruited with purposive sampling. A thematic analysis approach was employed and key themes were identified using open coding, grouping, and categorizing.
Forty-nine interviews were conducted. Thematic analysis identified three principal themes: the overall perception about SMOP, the benefits as observed; and the areas of improvement. Together with the 10 subthemes, the results highlighted the expectations for SMOP to address the unmet needs and promote patient-centered care, and the benefits of SMOP in supporting effective use of resources for the nursing home, reducing the risks of adverse events for the residents, promoting communication and capacity building for the healthcare providers and facilitating efficient use of healthcare resources for the health system. Requests for more frequent visits by a larger inter-disciplinary specialist team were raised. Careful staff and workflow planning, and mechanisms for data-sharing and communication across care settings were deemed the most important actions for improvement.
It is a general perception that the SMOP is beneficial in enhancing the quality of care for high-risk residents in the nursing home in Macao. Cross-sector inter-disciplinary collaboration and efficient data-sharing and communication mechanism play a crucial role in ensuring the success of the program. A robust assessment framework to monitor and evaluate the cost-effectiveness of the program is yet to be developed.
“专科医疗外展计划（SMOP）”是一项政府倡议，涉及跨学科医院医疗专业人员，旨在为养老院的高危居民提供综合专科护理。然而，缺乏对 SMOP 的实施和影响的研究。本研究旨在证明 SMOP 对养老院护理质量的影响，以及影响 SMOP 结果的关键背景决定因素。
对参与 SMOP 的养老院的 8 名经理、6 名医生、28 名护士和 7 名药剂师进行了半结构式关键知情人面对面录音访谈，以收集有关 SMOP 如何运作和表现的见解，以及观察到和预期的 SMOP 影响。参与者通过目的性抽样招募。采用主题分析方法，使用开放式编码、分组和分类确定主要主题。
共进行了 49 次访谈。主题分析确定了三个主要主题：对 SMOP 的总体看法、观察到的益处；和改进领域。连同 10 个子主题，结果强调了 SMOP 解决未满足需求和促进以患者为中心的护理的期望，以及 SMOP 支持养老院有效利用资源、降低居民不良事件风险、促进医疗保健提供者沟通和能力建设、为卫生系统促进高效利用医疗资源的益处。有人提出要求更多的跨学科专家团队更频繁地访问。精心的员工和工作流程规划，以及跨护理环境的数据共享和沟通机制被认为是改进的最重要行动。
普遍认为 SMOP 有助于提高澳门养老院高危居民的护理质量。跨部门跨学科合作以及有效的数据共享和沟通机制对于确保该计划的成功至关重要。尚未制定一个强大的评估框架来监测和评估该计划的成本效益。
