以工作为导向的临床护理的制定与实施：赋能肾病患者。一种适应性的干预映射方法。
Development and implementation of work-oriented clinical care to empower patients with kidney disease: an adapted intervention mapping approach.
机构信息
Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, RB, 9700, Groningen, the Netherlands.
Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, the Netherlands.
出版信息
BMC Health Serv Res. 2023 Apr 1;23(1):329. doi: 10.1186/s12913-023-09307-9.
BACKGROUND
Many people with chronic kidney disease (CKD) have problems to stay at work. Patients and health care professionals (HCPs) see the potential benefit of work-oriented clinical care, yet this care is not manifested in current practice. The aim of this study was to develop and implement a program called work-oriented clinical care for kidney patients (WORK) to support sustainable work participation.
METHODS
An adapted version of Intervention Mapping (AIM) was used for the systematic development of work-oriented care in a hospital. Based on the needs of patients and (occupational) health professionals, and in close cooperation with both, a theoretical and empirically based program was developed. Feasibility and clinical utility were assessed among patients with CKD, HCPs and hospital managers. To increase the chances of successful implementation we focused on determinants related to the innovation, the users, the organization (hospital), and socio-political context.
RESULTS
We developed, implemented, and pilot-tested WORK, an innovative program consisting of a care pathway in the hospital that targets patients with work-related questions and tailors the support they receive to their needs. Several practical tools were developed and an internal and external referral structure with a focus on work was implemented. A labor expert was deployed to the hospital to support patients and HCPs with simple work-related questions. The feasibility and clinical utility of WORK were rated positively.
CONCLUSIONS
This work-oriented clinical care program provides HCPs in the hospital with the necessary tools to support patients with CKD in dealing with work challenges. HCPs can discuss work with patients at an early stage and support them in anticipating work-related challenges. HCPs can also bridge the gap to more specialized help if necessary. WORK has the potential for wider application in other departments and hospitals. So far, the implementation of the WORK program was successful, though structural implementation may be challenging.
背景
许多慢性肾脏病（CKD）患者在工作中存在问题。患者和医疗保健专业人员（HCP）看到了以工作为导向的临床护理的潜在好处，但这种护理并没有在当前的实践中体现出来。本研究旨在开发和实施一项名为工作导向的肾脏患者临床护理（WORK）的计划，以支持可持续的工作参与。
方法
采用干预映射（AIM）的改编版本，在医院系统地开发以工作为导向的护理。根据患者和（职业）健康专业人员的需求，并与他们密切合作，开发了一个基于理论和实证的方案。在 CKD 患者、HCP 和医院管理人员中评估了可行性和临床实用性。为了增加成功实施的机会，我们专注于与创新、用户、组织（医院）和社会政治环境相关的决定因素。
结果
我们开发、实施并试点测试了 WORK，这是一个创新的方案，包括医院内的一条护理途径，针对有工作相关问题的患者，并根据他们的需求为他们提供所需的支持。开发了一些实用工具，并实施了内部和外部转诊结构，重点是工作。一名劳动专家被派往医院，为患者和 HCP 提供简单的工作相关问题的支持。WORK 的可行性和临床实用性得到了积极评价。
结论
这个以工作为导向的临床护理方案为医院的 HCP 提供了必要的工具，以帮助 CKD 患者应对工作挑战。HCP 可以在早期与患者讨论工作，并支持他们预测与工作相关的挑战。如果需要，HCP 还可以与更专业的帮助联系起来。WORK 有可能在其他部门和医院更广泛地应用。到目前为止，WORK 计划的实施是成功的，尽管结构性实施可能具有挑战性。
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