Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
Centre for Primary Care, University of Manchester Faculty of Medical and Human Sciences, Manchester, UK.
BMJ Qual Saf. 2024 Mar 25;33(4):232-245. doi: 10.1136/bmjqs-2023-016583.
Patients with heart failure with preserved ejection fraction (HFpEF) are a complex and underserved group. They are commonly older patients with multiple comorbidities, who rely on multiple healthcare services. Regional variation in services and resourcing has been highlighted as a problem in heart failure care, with few teams bridging the interface between the community and secondary care. These reports conflict with policy goals to improve coordination of care and dissolve boundaries between specialist services and the community.
To explore how care is coordinated for patients with HFpEF, with a focus on the interface between primary care and specialist services in England.
We applied systems thinking methodology to examine the relationship between work-as-imagined and work-as-done for coordination of care for patients with HFpEF. We analysed clinical guidelines in conjunction with a secondary applied thematic analysis of semistructured interviews with healthcare professionals caring for patients with HFpEF including general practitioners, specialist nurses and cardiologists and patients with HFpEF themselves (n=41). Systems Thinking for Everyday Work principles provided a sensitising theoretical framework to facilitate a deeper understanding of how these data illustrate a complex health system and where opportunities for improvement interventions may lie.
Three themes (working with complexity, information transfer and working relationships) were identified to explain variability between and . Participants raised educational needs, challenging work conditions, issues with information transfer systems and organisational structures poorly aligned with patient needs.
There are multiple challenges that affect coordination of care for patients with HFpEF. Findings from this study illuminate the complexity in coordination of care practices and have implications for future interventional work.
射血分数保留型心力衰竭（HFpEF）患者是一个复杂且未得到充分治疗的群体。他们通常是患有多种合并症的老年患者，依赖多种医疗保健服务。服务和资源的区域差异已被强调为心力衰竭护理中的一个问题，很少有团队能够弥合社区和二级护理之间的界面。这些报告与改善护理协调和消除专科服务与社区之间界限的政策目标相冲突。
探讨如何协调 HFpEF 患者的护理，重点关注英格兰初级保健和专科服务之间的接口。
我们应用系统思维方法来检查 HFpEF 患者护理协调的想象中的工作和实际中的工作之间的关系。我们分析了临床指南，并结合对照顾 HFpEF 患者的医疗保健专业人员（包括全科医生、专科护士和心脏病专家以及 HFpEF 患者本身）进行的半结构化访谈的二次应用主题分析（n=41）。系统思维日常工作原则提供了一个敏感的理论框架，以帮助更深入地了解这些数据如何说明一个复杂的卫生系统，以及改进干预措施的机会可能在哪里。
确定了三个主题（处理复杂性、信息传递和工作关系）来解释 和 之间的差异。参与者提出了教育需求、具有挑战性的工作条件、信息传递系统和组织结构问题，这些问题与患者的需求不匹配。
有多个挑战影响 HFpEF 患者的护理协调。这项研究的结果阐明了协调护理实践中的复杂性，并对未来的干预性工作产生影响。
