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为患有多种疾病的老年人调整并实施混合式协作护理干预措施:ESCAPE试点研究的定量和定性结果

Adapting and Implementing a Blended Collaborative Care Intervention for Older Adults with Multimorbidity: Quantitative and Qualitative Results from the ESCAPE Pilot Study.

作者信息

Schulze Josefine, Lühmann Dagmar, Nagel Jonas, Regner Cornelia, Zelenak Christine, Bersch Kristina, Herrmann-Lingen Christoph, Burg Matthew M, Herbeck-Belnap Birgit

机构信息

Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.

Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Göttingen, 37073 Göttingen, Germany.

出版信息

Behav Sci (Basel). 2025 Jan 17;15(1):79. doi: 10.3390/bs15010079.

Abstract

Multimorbidity poses significant challenges for patients and healthcare systems, often exacerbated by fragmented care and insufficient collaboration across providers. Blended Collaborative Care (BCC) is a promising strategy to address care complexity by partnering care managers (CMs) with primary care providers (PCPs) and specialists. This study aimed to adapt and pilot a BCC intervention for patients aged 65+ with heart failure and physical-mental multimorbidity. Our objectives were to assess the feasibility of the study procedures, patient recruitment, participant satisfaction and acceptability, and to identify necessary adjustments for improving intervention delivery. We evaluated goal attainment and intervention fidelity through standardised electronic documentation by CMs, and patient acceptance and satisfaction through semi-structured interviews. A monocentric, one-arm pilot study involved nine patients with a mean of 6.7 contacts with their CM over three months. Patients' health goals primarily focused on lifestyle changes and psychosocial support. The intervention was generally well-accepted, with no reported negative consequences. Difficulties in establishing working alliances with PCPs were a barrier to effective implementation. The analysis indicated the need for minor procedural adjustments. Next steps include launching the ESCAPE trial, a large randomised-controlled trial across different European healthcare systems and developing strategies to facilitate PCP involvement.

摘要

多种疾病共患给患者和医疗系统带来了重大挑战,而医疗服务的碎片化以及各医疗服务提供者之间协作不足往往会使这些挑战进一步加剧。混合协作式照护(BCC)是一种很有前景的策略,通过让照护经理(CM)与初级保健提供者(PCP)及专科医生合作来应对照护的复杂性。本研究旨在针对65岁及以上患有心力衰竭且存在身心共病的患者调整并试行BCC干预措施。我们的目标是评估研究程序、患者招募、参与者满意度和可接受性的可行性,并确定改善干预措施实施所需的调整。我们通过CM的标准化电子文档评估目标达成情况和干预保真度,并通过半结构化访谈评估患者的接受度和满意度。一项单中心、单臂试点研究纳入了9名患者,他们在三个月内平均与CM联系6.7次。患者的健康目标主要集中在生活方式改变和心理社会支持方面。该干预措施总体上得到了良好接受,未报告有负面后果。与PCP建立工作联盟存在困难是有效实施的一个障碍。分析表明需要对程序进行一些小的调整。下一步包括开展ESCAPE试验,这是一项针对不同欧洲医疗系统的大型随机对照试验,以及制定促进PCP参与的策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7374/11762138/6f442a066d43/behavsci-15-00079-g001.jpg

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