提高基于初级保健的痴呆症患者和照护者的诊断后支持：使用变革理论开发复杂干预措施。
Improving primary care based post-diagnostic support for people living with dementia and carers: Developing a complex intervention using the Theory of Change.
机构信息
Population Health Sciences Institute, Faculty of Medical Sciences, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom.
Research Department of Primary Care & Population Health, University College London, London, United Kingdom.
出版信息
PLoS One. 2023 May 3;18(5):e0283818. doi: 10.1371/journal.pone.0283818. eCollection 2023.
BACKGROUND
The need to improve support following a diagnosis of dementia is widely recognised, but it is unclear how this can best be achieved within UK health and social care systems. A task-shared and task-shifted approach has been recommended, but there is limited guidance on how to achieve this in practice. As part of a programme of research, we developed an intervention to enhance the role of primary care in post-diagnostic care and support for people living with dementia and carers.
METHODS
We used the Theory of Change to develop a complex intervention informed by initial literature reviews and qualitative work. The intervention was developed through an iterative series of workshops, meetings and task groups with a range of stakeholders, including the multidisciplinary project team, people living with dementia and carers, service managers, frontline practitioners, and commissioners.
RESULTS
142 participants contributed to intervention development through face-to-face or virtual meetings. The intervention comprises three complementary strands of work focusing on: developing systems, delivering tailored care and support, and building capacity and capability. Clinical dementia leads, based in primary care networks, will facilitate the intervention providing tailored expertise and support.
CONCLUSION
The Theory of Change proved useful in providing structure and engaging stakeholders. The process was challenging, took longer and was less participative than intended due to restrictions caused by the COVID-19 pandemic. We will next conduct a feasibility and implementation study to explore whether the intervention can be successfully delivered within primary care. If successful, the intervention offers practical strategies for delivering a task-shared and task-shifted approach to post-diagnostic support that could be adapted for similar health and social care contexts internationally.
背景
广泛认识到需要改善痴呆症诊断后的支持，但尚不清楚如何在英国卫生和社会保健系统中最好地实现这一目标。推荐采用分工和转移任务的方法，但在实践中如何实现这一目标的指导有限。作为研究计划的一部分，我们开发了一种干预措施，以增强初级保健在为痴呆症患者和照顾者提供诊断后护理和支持方面的作用。
方法
我们使用变革理论来开发一种复杂的干预措施，该措施以初步文献综述和定性工作为依据。该干预措施是通过一系列与各种利益相关者（包括多学科项目团队、痴呆症患者和照顾者、服务经理、一线从业者和专员）的迭代研讨会、会议和工作组开发的。
结果
142 名参与者通过面对面或虚拟会议为干预措施的制定做出了贡献。该干预措施由三个互补的工作部分组成，重点是：发展系统、提供量身定制的护理和支持以及建立能力和能力。初级保健网络中的临床痴呆领导将促进干预措施，提供量身定制的专业知识和支持。
结论
变革理论在提供结构和吸引利益相关者方面非常有用。由于 COVID-19 大流行造成的限制，该过程具有挑战性，耗时更长，参与度低于预期。我们将下一步进行可行性和实施研究，以探索该干预措施是否可以在初级保健中成功实施。如果成功，该干预措施为提供诊断后支持的分工和转移任务方法提供了实用策略，可适应国际上类似的卫生和社会保健环境。
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