商业供应商员工对国民保健制度低卡路里饮食计划试点的体验：对主要障碍和促进因素的定性探索。

Commercial provider staff experiences of the NHS low calorie diet programme pilot: a qualitative exploration of key barriers and facilitators.

机构信息

School of Health & Life Sciences, Teesside University, Centuria Building, Middlesbrough, North Yorkshire, TS1 3BX, UK.

Obesity Institute, School of Health, Leeds Beckett University, City Campus, Leeds, LS6 3QW, UK.

出版信息

BMC Health Serv Res. 2024 Jan 10;24(1):53. doi: 10.1186/s12913-023-10501-y.

DOI:10.1186/s12913-023-10501-y

PMID:38200539

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10782528/

Abstract

BACKGROUND

The National Health Service Type 2 Diabetes Path to Remission programme in England (known as the NHS Low Calorie Diet programme when piloted) was established to support people living with excess weight and Type 2 Diabetes to lose weight and improve their glycaemic control. A mixed method evaluation was commissioned to provide an enhanced understanding of the long-term cost effectiveness of the pilot programme, its implementation, equity and transferability across broad and diverse populations. This study provided key insights on implementation and equity from the service providers' perspective.

METHODS

Thirteen focus groups were conducted with commercial providers of the programme, during the initial pilot rollout. Participants were purposively sampled across all provider organisations and staff roles involved in implementing and delivering the programme. Normalisation Process Theory (NPT) was used to design the topic schedule, with the addition of topics on equity and person-centredness. Data were thematically analysed using NPT constructs with additional inductively created codes. Codes were summarised, and analytical themes generated.

RESULTS

The programme was found to fulfil the requirements for normalisation from the providers' perspective. However, barriers were identified in engaging GP practices and receiving sufficient referrals, as well as supporting service users through challenges to remain compliant. There was variation in communication and training between provider sites. Areas for learning and improvement included adapting systems and processes and closing the gap where needs of service users are not fully met.

CONCLUSIONS

The evaluation of the pilot programme demonstrated that it was workable when supported by effective primary care engagement, comprehensive training, and effective internal and external communication. However, limitations were identified in relation to programme specifications e.g. eligibility criteria, service specification and local commissioning decisions e.g. pattern of roll out, incentivisation of general practice. A person-centred approach to care is fundamental and should include cultural adaptation(s), and the assessment and signposting to additional support and services where required.

摘要

背景

英国国民保健服务 2 型糖尿病缓解计划（在试点阶段称为国民保健服务低热量饮食计划）旨在支持超重和 2 型糖尿病患者减轻体重并改善血糖控制。委托进行了一项混合方法评估，以更深入地了解试点计划的长期成本效益、实施情况、公平性以及在广泛和多样化人群中的可转移性。本研究从服务提供者的角度提供了关于实施情况和公平性的重要见解。

方法

在最初的试点阶段，与该计划的商业提供者进行了 13 次焦点小组讨论。参与者是根据所有参与实施和提供该计划的提供者组织和工作人员角色进行有目的抽样的。使用规范化进程理论（NPT）设计主题时间表，并增加了关于公平性和以人为中心的主题。使用 NPT 结构对数据进行主题分析，并使用额外的归纳创建代码进行分析。对代码进行总结，并生成分析主题。

结果

从提供者的角度来看，该计划被发现符合规范化的要求。然而，在参与全科医生实践和获得足够的转介方面，以及在支持服务用户克服合规挑战方面，都存在障碍。提供者站点之间的沟通和培训存在差异。需要学习和改进的领域包括调整系统和流程，以及缩小服务用户需求未得到充分满足的差距。

结论

对试点计划的评估表明，在得到有效的初级保健参与、全面培训以及有效的内部和外部沟通的支持下，该计划是可行的。然而，在计划规范方面，如资格标准、服务规范和地方委托决策方面，如推出模式、激励全科医生，都存在局限性。以患者为中心的护理方法是基础，应包括文化适应（如），并在需要时评估和转介到额外的支持和服务。