老年手术患者围手术期医学服务的实施：一项定性案例研究。

The implementation of a perioperative medicine for older people undergoing surgery service: a qualitative case study.

机构信息

National Centre for Healthy Ageing, Melbourne, Australia.

Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Australia.

出版信息

BMC Health Serv Res. 2024 Mar 15;24(1):345. doi: 10.1186/s12913-024-10844-0.

DOI:10.1186/s12913-024-10844-0

PMID:38491431

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10943911/

Abstract

BACKGROUND

The international scale and spread of evidence-based perioperative medicine for older people undergoing surgery (POPS) services has not yet been fully realised. Implementation science provides a structured approach to understanding factors that act as barriers and facilitators to the implementation of POPS services. In this study, we aimed to identify factors that influence the implementation of POPS services in the UK.

METHODS

A qualitative case study at three UK health services was undertaken. The health services differed across contextual factors (population, workforce, size) and stages of POPS service implementation maturity. Semi-structured interviews with purposively sampled clinicians (perioperative medical, nursing, allied health, and pharmacy) and managers (n = 56) were conducted. Data were inductively coded, then thematically analysed using the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Fourteen factors across all five CFIR domains were relevant to the implementation of POPS services. Key shared facilitators included stakeholders understanding the rationale of the POPS service, with support from their networks, POPS champions, and POPS clinical leads. We found substantial variation and flexibility in the way that health services responded to these shared facilitators and this was relevant to the implementation of POPS services.

CONCLUSIONS

Health services planning to implement a POPS service should use health service-specific strategies to respond flexibly to local factors that are acting as barriers or facilitators to implementation. To support implementation of a POPS service, we recommend health services prioritise understanding local networks, identifying POPS champions, and ensuring that stakeholders understand the rationale for the POPS service. Our study also provides a structure for future research to understand the factors associated with 'unsuccessful' implementation of a POPS service, which can inform ongoing efforts to implement evidence-based perioperative models of care for older people.

摘要

背景

针对接受手术的老年人（POPS）的循证围手术期医学国际规模和普及程度尚未完全实现。实施科学为理解对 POPS 服务实施的障碍和促进因素提供了一种结构化的方法。在这项研究中，我们旨在确定影响英国 POPS 服务实施的因素。

方法

在三个英国卫生服务机构进行了定性案例研究。这些卫生服务在背景因素（人口、劳动力、规模）和 POPS 服务实施成熟度阶段方面存在差异。对来自围手术期医疗、护理、联合健康和药剂学的有目的抽样临床医生（n=56）和管理人员进行了半结构化访谈。使用实施研究综合框架（CFIR）对数据进行归纳编码，然后进行主题分析。

结果

所有五个 CFIR 领域都有 14 个因素与 POPS 服务的实施相关。关键的共同促进因素包括利益相关者了解 POPS 服务的基本原理，并得到他们的网络、POPS 拥护者和 POPS 临床负责人的支持。我们发现，卫生服务机构对这些共同促进因素的反应方式存在很大的差异和灵活性，这与 POPS 服务的实施有关。

结论

计划实施 POPS 服务的卫生服务机构应使用针对特定卫生服务的策略，灵活应对作为实施障碍或促进因素的本地因素。为了支持 POPS 服务的实施，我们建议卫生服务机构优先了解本地网络、确定 POPS 拥护者，并确保利益相关者了解 POPS 服务的基本原理。我们的研究还为未来研究提供了一个结构，以了解与 POPS 服务“不成功”实施相关的因素，这可以为实施针对老年人的循证围手术期护理模式提供信息。