Levelink Michael, Brütt Anna Levke
Carl von Ossietzky Universität Oldenburg, Fakultät VI, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Oldenburg, Deutschland.
Carl von Ossietzky Universität Oldenburg, Fakultät VI, Department für Versorgungsforschung, Nachwuchsgruppe Rehaforschung, Oldenburg, Deutschland; Universitätsklinikum Hamburg-Eppendorf, Institut und Poliklinik für Medizinische Psychologie, Hamburg, Deutschland.
Z Evid Fortbild Qual Gesundhwes. 2024 Sep;189:33-42. doi: 10.1016/j.zefq.2024.07.001. Epub 2024 Aug 12.
Implantation of a left ventricular assist device (LVAD) requires extensive aftercare. It is largely unclear how aftercare should be designed from the patients' perspective. Implications can be developed based on an examination of the healthcare context. Its main components are mapped on five tiers in the Human Factors of Home Health Care Model by Henriksen, Joseph, and Zayas-Caban (2009). Using this model, the present study explores the patient perspective on the context of healthcare after an LVAD implantation.
We employed a qualitative cross-sectional study, in which LVAD patients participated in semi-structured interviews. The transcribed interviews were analyzed using content analysis. First, relevant meaning units were identified and deductively categorized into the model. Then, categories of care-related aspects were developed inductively within each of the model tiers.
We interviewed 18 patients aged 33 to 78 years who had been living with the LVAD between a few weeks and more than 10 years. Twenty-eight categories related to care aspects were developed within the model tiers: 3 categories on patient characteristics (e.g., self-management skills), 3 on caregiver characteristics (e.g., professionalism), 11 healthcare-related tasks and requirements (e.g., wound management), 8 on factors of the physical environment (e.g., controllability), medical devices and technologies (e.g., carrying systems for external components), and cultural, social and community environment (e.g., interaction with peers), as well as 3 on external environmental factors (e.g., healthcare infrastructure).
The present study represents the first investigation focusing on aspects of the healthcare context influencing healthcare quality and safety from the perspective of LVAD patients in Germany. LVAD aftercare covers a broad and complex range of tasks. For this, patients, caregivers and healthcare professionals need specific knowledge, which is lacking in various respects. In the first place, this is compensated by the patients' own initiative and the personal care provided by the VAD outpatient clinics.
Three key recommendations to optimize aftercare from the patient perspective are derived: Patients would benefit from a more flexible and decentralized aftercare concept, to which telemedicine could contribute. LVAD-specific expertise among general healthcare providers is perceived as insufficient by patients and could be strengthened through training and counseling services. The broad scope of tasks and the high level of responsibilities in LVAD aftercare pose challenges for patients and their families, which could be addressed through continuous information and training programs.
植入左心室辅助装置（LVAD）需要广泛的术后护理。从患者的角度来看，术后护理应如何设计在很大程度上尚不清楚。可以基于对医疗保健环境的考察来提出相关建议。其主要组成部分在Henriksen、Joseph和Zayas-Caban（2009年）的家庭医疗保健模型的人为因素中被映射到五个层次。本研究使用该模型，从患者的角度探讨LVAD植入术后医疗保健环境的相关问题。
我们采用了一项定性横断面研究，让LVAD患者参与半结构化访谈。对转录后的访谈内容进行了内容分析。首先，确定相关的意义单元，并将其演绎分类到该模型中。然后，在模型的每个层次内归纳出与护理相关的类别。
我们采访了18名年龄在33至78岁之间的患者，他们使用LVAD的时间从几周至10多年不等。在模型层次内形成了28个与护理方面相关的类别：3个关于患者特征（如自我管理技能），3个关于护理人员特征（如专业素养），11个与医疗保健相关的任务和要求（如伤口处理），8个关于物理环境因素（如可控性）、医疗设备和技术（如外部组件的携带系统）以及文化、社会和社区环境（如同伴互动），还有3个关于外部环境因素（如医疗保健基础设施）。
本研究是德国首次从LVAD患者的角度，针对影响医疗质量和安全的医疗保健环境方面展开的调查。LVAD术后护理涵盖了广泛而复杂的一系列任务。为此，患者、护理人员和医疗保健专业人员需要特定的知识，而这些知识在各个方面都有所欠缺。首先，这通过患者自身的主动性以及VAD门诊提供的个人护理得到了一定程度的弥补。
从患者角度出发，得出了优化术后护理的三项关键建议：患者将受益于更灵活、去中心化的术后护理理念，远程医疗可为此做出贡献。患者认为普通医疗保健提供者缺乏LVAD方面的专业知识，可通过培训和咨询服务加以强化。LVAD术后护理任务范围广泛且责任重大，给患者及其家人带来了挑战，可通过持续的信息和培训项目来应对。
