Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, Oxford, OX3 7JX, UK.
Institute for Health Research, University of Bedfordshire, Hitchin Road, Luton, LU2 8LE, UK.
BMC Geriatr. 2024 Oct 14;24(1):832. doi: 10.1186/s12877-024-05412-4.
The NHS has made it mandatory for General Practices in England to proactively identify and manage older people with moderate and severe frailty since the GMS contract of 2017/2018. In Luton, stakeholders developed the Luton Framework of Frailty (LFF) to implement this national policy. The aim of this study was to explore the factors that affect the implementation of this national policy at a local level.
In-depth interviews were conducted with 18 commissioners and service providers, all of whom were involved in providing services for older people with different frailty levels (OPDFL). Purposive and snowball sampling methods were used, with thematic analysis used for data analysis.
Two main themes with several sub-themes were found. The first theme was the tension within existing national policy initiatives to provide integrated care services for OPDFL, which illuminated their strengths and limitations. Participants felt that new initiatives, such as the development of Primary Care Networks and Enhanced Health in Care Homes, have improved primary care coordination. However, the traditional reactive approach for managing older people who are frail was thought to be counterproductive, when an approach that focused on prevention and early intervention would have been better. The second theme concerned the contextual factors that affect implementation of integrated care. These included having key leaders at a local level, the requirement for more funding, as well as the need for good working relationships among service providers. However, the lack of awareness about the care pathways among GPs was thought to be a reason for the variation in the implementation of the LFF. The COVID-19 pandemic was perceived as a challenge for the implementation of the LFF. Finally, polices were thought to succeed only if more resources are provided, while the term frailty should be used with caution due to the negative connotations of OPDFL towards this term.
The implementation of an integrated care programme for OPDFL can be affected by several factors. Having proactive national policies that facilitate coordination and, having key leaders locally, the need for more funding, and good working relationships, are some of the contextual factors that could facilitate a successful implementation. In contrast, the lack of awareness of the care pathways that have been introduced locally, insufficient resources to deliver the programmes efficiently and a lack of careful consideration of how the term frailty is used could hinder this being put into practice.
自 2017-2018 年国民保健制度（NHS）下的全科医生服务合同实施以来，英国国民保健制度已强制要求各全科医生主动识别和管理中重度虚弱的老年人。在卢顿，利益相关者制定了卢顿虚弱框架（LFF）来实施这一国家政策。本研究旨在探讨影响国家政策在地方层面实施的因素。
对 18 名决策者和服务提供者进行了深入访谈，他们都参与了为不同虚弱程度的老年人（OPDFL）提供服务。采用了目的性和滚雪球抽样方法，使用主题分析进行数据分析。
发现了两个有几个子主题的主题。第一个主题是为 OPDFL 提供综合护理服务的现有国家政策举措之间的紧张关系，这凸显了它们的优势和局限性。参与者认为，新举措，如初级保健网络的发展和增强护理院的健康状况，改善了初级保健的协调。然而，传统的针对虚弱老年人的被动管理方法被认为是适得其反的，而采取预防和早期干预的方法会更好。第二个主题涉及影响综合护理实施的背景因素。这些因素包括在地方一级有主要领导人、需要更多资金以及服务提供者之间需要良好的工作关系。然而，全科医生对护理途径缺乏认识被认为是 LFF 实施情况存在差异的原因。COVID-19 大流行被认为是 LFF 实施的挑战。最后，人们认为，只有提供更多资源，政策才能成功，而由于 OPDFL 对这个术语的负面含义，虚弱这个词应该谨慎使用。
OPDFL 综合护理计划的实施可能受到几个因素的影响。积极主动的国家政策促进协调，以及在地方一级有主要领导人、需要更多资金和良好的工作关系等背景因素，可以促进成功实施。相比之下，对当地引入的护理途径缺乏认识、提供方案的资源不足以及对如何使用虚弱这个词缺乏谨慎考虑，可能会阻碍这一方案的实施。
