关于医疗保健中“缺失”现象的成因及当前应对措施的实证性综述。
A realist review of the causes of, and current interventions to address 'missingness' in health care.
作者信息
Lindsay Calum, Baruffati David, Mackenzie Mhairi, Ellis David A, Major Michelle, O'Donnell Kate, Simpson Sharon, Williamson Andrea, Duddy Claire, Wong Geoff
机构信息
General Practice and Primary Care, University of Glasgow, Glasgow, Scotland, UK.
Urban Studies, University of Glasgow, Glasgow, Scotland, UK.
出版信息
NIHR Open Res. 2024 Aug 1;3:33. doi: 10.3310/nihropenres.13431.2. eCollection 2023.
BACKGROUND
This protocol describes a realist review exploring the problem of "missingness" in healthcare, defined as the repeated tendency not to take up offers of care that has a negative impact on the person and their life chances. More specifically, the review looks at the phenomenon of patients missing multiple appointments in primary care in the UK - at the causal factors that influence how patients come to be "missing" in this way, and what interventions might support uptake and "presence" in healthcare. Background research informing this project suggests that a high rate of missed appointments predicted high premature death rates, and patients were more likely to have multiple long-term health conditions and experience significant socioeconomic disadvantage. Most research in this field focuses on population- or service-level characteristics of patients who miss appointments, often making no distinction between causes of single missed appointments and of multiple missed appointments. There have therefore been no interventions for 'missingness', accounting for the complex life circumstances or common mechanisms that cause people to repeatedly miss appointments.
METHODS
We use a realist review approach to explore what causes missingness - and what might prevent or address it - for whom, and in what circumstances. The review uses an iterative approach of database searching, citation-tracking and sourcing grey literature, with selected articles providing insight into the causal dynamics underpinning missed appointments and the interventions designed to address them.
DISCUSSION
The findings of this review will be combined with the findings of a qualitative empirical study and the contributions of a Stakeholder Advisory Group (STAG) to inform the development of a programme theory that seeks to explain how missingness occurs, whom it affects and under what circumstances. This will be used to develop a complex intervention to address multiple missed appointments in primary care.
PROSPERO REGISTRATION
CRD42022346006.
背景
本方案描述了一项现实主义综述，探讨医疗保健中的“失约”问题，即反复出现的不接受医疗服务的倾向，这对个人及其生活机会产生负面影响。更具体地说，该综述关注英国初级保健中患者多次错过预约的现象——影响患者以这种方式“失约”的因果因素，以及哪些干预措施可能有助于提高医疗服务的利用率和“就诊率”。为本项目提供信息的背景研究表明，高失约率预示着高过早死亡率，患者更有可能患有多种长期健康状况，并经历重大的社会经济劣势。该领域的大多数研究都集中在错过预约的患者的人群或服务层面特征上，往往没有区分单次错过预约和多次错过预约的原因。因此，尚未有针对“失约”的干预措施，未考虑导致人们反复错过预约的复杂生活情况或共同机制。
方法
我们采用现实主义综述方法，探讨失约的原因——以及哪些因素可能预防或解决失约问题——针对哪些人，以及在何种情况下。该综述采用迭代方法，包括数据库搜索、引文跟踪和获取灰色文献，所选文章深入了解导致错过预约的因果动态以及旨在解决这些问题的干预措施。
讨论
本综述的结果将与定性实证研究的结果以及利益相关者咨询小组（STAG）的贡献相结合，为项目理论的发展提供信息，该理论旨在解释失约是如何发生的、影响哪些人以及在何种情况下发生。这将用于制定一项复杂的干预措施，以解决初级保健中多次错过预约的问题。
PROSPERO注册编号：CRD42022346006。
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