Department of Health Services & Population Research, King's College London, London, UK
Division of Methodologies, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK.
BMJ Open. 2023 Jan 23;13(1):e066883. doi: 10.1136/bmjopen-2022-066883.
Our aim was to examine the feasibility and implementation of a complex intervention to improve the care of patients with peripheral arterial disease (the LEGS intervention) from the perspective of patients, general practitioners and secondary care clinicians.
A qualitative study involving semistructured individual interviews with patients and providers to gain an understanding of the feasibility of the LEGS intervention as well the barriers and facilitators to implementation in secondary and primary care.
Primary and secondary care settings across two National Health Service Trusts.
Twenty-five semistructured telephone interviews were conducted with (1) patients who had received the intervention (n=11), (2) secondary care clinicians responsible for delivering the intervention (n=8) and (3) general practitioners (n=6).
Data were initially analysed using inductive descriptive thematic analysis. The consolidated framework for implementation research was then used as a matrix to explore patterns in the data and to map connections between the three participant groups. Lastly, interpretive analysis allowed for refining, and a final coding frame was developed.
Four overarching themes were identified: (1) the potential to make a difference, (2) a solution to address the gap in no man's land, (3), prioritising and making it happen and (4) personalised information and supportive conversations for taking on the advice. The impetus for prioritising and delivering the intervention was further driven by its flexibility and adaptability to be tailored to the individual and to the environment.
The LEGS intervention can be tailored for use at early and late stages of peripheral arterial disease, provides an opportunity to meet patient needs and can be used to promote shared working across the primary-secondary care interface.
本研究旨在从患者、全科医生和二级保健临床医生的角度，考察改善外周动脉疾病（LEGS 干预）患者护理的复杂干预措施的可行性和实施情况。
一项定性研究，包括对外周动脉疾病患者和提供者进行半结构化个体访谈，以了解 LEGS 干预的可行性，以及在二级和初级保健中实施的障碍和促进因素。
两个国民保健制度信托基金的二级和初级保健机构。
对（1）接受干预的患者（n=11）、（2）负责提供干预的二级保健临床医生（n=8）和（3）全科医生（n=6）进行了 25 次半结构化电话访谈。
最初使用归纳描述性主题分析方法分析数据。然后，使用综合实施研究框架作为矩阵，探索数据中的模式，并映射三个参与者群体之间的联系。最后，进行解释性分析以进行细化，并制定最终的编码框架。
确定了四个总体主题：（1）产生影响的潜力，（2）解决无人区差距的解决方案，（3）优先考虑并实现，（4）提供个性化信息和支持性对话以接受建议。推动优先考虑和实施干预的动力还来自于其灵活性和适应性，可以根据个人和环境进行调整。
LEGS 干预可以针对外周动脉疾病的早期和晚期进行调整，为满足患者需求提供了机会，并可用于促进初级保健和二级保健之间的共同工作。
