Department of Infectious disease, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
Department of Public Health, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
J Glob Health. 2023 Jan 20;13:04005. doi: 10.7189/13.04005.
A growing global shortage of health workers is limiting access to health care, especially in resource-limited countries. Family participation in hospital care could enhance care while tackling health worker shortages. With the same resources, it might deliver additional and more personalised care. This review assessed the effect and safety of family participation interventions in the care of hospitalised adults in resource-limited settings and, ultimately, if it is a viable strategy to tackle health worker shortages.
For this systematic review, Medline, Embase, CINAHL and the Global Health Library were searched from inception till April 7, 2022. Clinical studies were included if they described a family participation intervention for hospitalised adults, were performed in a low- or middle-income country and reported on a patient-related outcome. Data were collected on patient, family, staff and health service-related outcomes. Risk of bias was assessed with the ROB2 and ROBINS-I tool.
From 4444 studies, six were included for narrative synthesis, with a total of 1794 participants. Four studies were performed in Asia and two in Africa; all were published between 2017 and 2022. In-hospital family participation interventions aimed at medication administration and adherence, delirium prevention, and palliative cancer care were successful in significantly improving patient outcomes. Involving family in post-stroke rehabilitation interventions showed no significant effect on mortality and long-term disability. Few data were reported on participating family members' outcomes or hospital staffing issues. None of the included studies showed harm from family participation.
The limited data suggest that family participation can be effective and safe in specific contexts. However, more research is needed to determine the effect of family participation and justify further implementation. Family participation research for enhancing care while tackling health worker shortages should be a collaborative priority of researchers, health care professionals, funding agencies and policymakers.
PROSPERO registration No. CRD42020205878.
全球卫生工作者短缺日益严重，限制了医疗保健的可及性，尤其是在资源有限的国家。家庭成员参与医院护理可以在解决卫生工作者短缺问题的同时提高护理质量。利用相同的资源，可能会提供更多个性化的护理。本综述评估了在资源有限的环境中，家庭成员参与住院成人护理的干预措施的效果和安全性，以及它是否是解决卫生工作者短缺问题的可行策略。
本系统综述检索了 Medline、Embase、CINAHL 和全球卫生图书馆，检索时间从建库开始至 2022 年 4 月 7 日。如果研究描述了针对住院成人的家庭参与干预措施，且在中低收入国家进行，并报告了与患者相关的结局，则纳入临床研究。研究收集了患者、家庭、医护人员和卫生服务相关结局的数据。使用 ROB2 和 ROBINS-I 工具评估偏倚风险。
从 4444 篇研究中，有 6 篇研究进行了叙述性综合分析，共纳入 1794 名参与者。4 项研究在亚洲进行，2 项在非洲进行；所有研究均在 2017 年至 2022 年期间发表。旨在改善药物管理和依从性、预防谵妄和姑息治疗癌症的住院期间家庭参与干预措施，显著改善了患者结局。参与中风后康复干预的家庭对死亡率和长期残疾没有显著影响。关于参与家庭的结局或医院人员配备问题的数据很少。纳入的研究均未显示家庭参与存在危害。
有限的数据表明，在特定情况下，家庭参与可能是有效和安全的。然而，还需要更多的研究来确定家庭参与的效果，并证明进一步实施的合理性。在解决卫生工作者短缺问题的同时，提高护理质量，应成为研究人员、医疗保健专业人员、资助机构和政策制定者的协作重点。
PROSPERO 注册号：CRD42020205878。
