基层医疗中可持续预防跌倒的综合解决方案：一项务实的混合型2混合方法实施与效果研究。

Integrated solutions for sustainable fall prevention in primary care: a pragmatic hybrid-type 2 mixed methods implementation and effectiveness study.

作者信息

Clemson Lindy, Mackenzie Lynette, Lovarini Meryl, Roberts Christopher, Poulos Roslyn, Sherrington Catherine, Tan Amy C W, Simpson Judy, Pond Constance Dimity, Pit Sabrina, Tiedemann Anne, Lovitt Lorraine, Hilmer Sarah N

机构信息

Ageing and Health Research Group, The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

Sydney Medical School, The Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.

出版信息

Front Public Health. 2024 Dec 5;12:1446525. doi: 10.3389/fpubh.2024.1446525. eCollection 2024.

DOI:10.3389/fpubh.2024.1446525

PMID:39703488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11656318/

Abstract

UNLABELLED

The iSOLVE implementation project established and evaluated integrated processes and pathways, including a decision-making tool and educational interventions for general medical practitioners (GPs) and the upskilling of allied health professionals (AHPs). The study used a mixed-methods (parallel) design comprising surveys, qualitative methodologies, and an embedded cluster randomized controlled trial (RCT). Sampling was conducted within a Primary Health Network (PHN) geographic area in Sydney, Australia. AHP workshops ( = 367 attendees) covered six evidence-based interventions, resulting in increased confidence ( < 0.001) and numerous enhancements in fall prevention delivery. Among GPs, 75 were recruited from 27 practices. GPs in the experimental group were more likely to engage in fall prevention activities, including risk assessments, medication reviews, and providing advice, compared to the control group ( = 0.002). They were also more likely to refer patients to AHPs at 3 months ( = 0.002); however, this effect was not significant at 12 months ( = 0.13), as referral behaviors increased in the control group over time. Responses to free-text questions of practice change highlighted differences, with the experimental group reporting a more proactive and comprehensive approach to fall prevention. In a subset of GP patients ( = 560), no significant effect was observed in reducing the rate of falls (IRR = 0.96). The pragmatic nature of the project and potential contamination across multiple elements likely influenced this outcome. However, an area-wide survey of GPs ( = 562) revealed an increase in fall prevention referrals to AHPs over 5 years, from 70 to 82% ( = 0.028). Our findings highlight the importance of equipping GPs with tools and strategies to adopt a proactive approach to fall prevention among older patients. AHPs play a crucial role in this effort, and fostering relationships and connectivity across primary care networks is essential to maximizing the impact of fall prevention initiatives.

CLINICAL TRIAL REGISTRATION

Australian New Zealand Clinial Trials Registry, ACTRN12615000401550, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368286.

摘要

未标注

iSOLVE实施项目建立并评估了综合流程和路径，包括为全科医生（GP）提供的决策工具和教育干预措施，以及提升辅助医疗专业人员（AHP）的技能。该研究采用了混合方法（平行）设计，包括调查、定性方法和一项嵌入式整群随机对照试验（RCT）。抽样在澳大利亚悉尼的一个初级卫生保健网络（PHN）地理区域内进行。AHP研讨会（367名参与者）涵盖了六种循证干预措施，结果是信心增强（<0.001），并且在预防跌倒服务方面有多项改进。在全科医生中，从27家诊所招募了75人。与对照组相比，实验组的全科医生更有可能参与预防跌倒活动，包括风险评估、药物审查和提供建议（=0.002）。他们在3个月时也更有可能将患者转诊给AHP（=0.002）；然而，这种效果在12个月时并不显著（=0.13），因为随着时间的推移，对照组的转诊行为有所增加。对关于实践改变的自由文本问题的回答突出了差异，实验组报告在预防跌倒方面采取了更积极主动和全面的方法。在一部分全科医生的患者（560人）中，未观察到在降低跌倒发生率方面有显著效果（发病率比值比=0.96）。该项目的务实性质以及多个要素之间可能的交叉影响可能影响了这一结果。然而，一项针对全科医生的全区域调查（562人）显示，在5年时间里，将患者转诊给AHP进行预防跌倒的比例从70%增加到了82%（=0.028）。我们的研究结果突出了为全科医生配备工具和策略以在老年患者中采取积极主动的预防跌倒方法的重要性。AHP在这项工作中发挥着关键作用，并且促进初级保健网络之间的关系和联系对于最大化预防跌倒举措的影响至关重要。