Ramachandran Jeyamani, Pati Anuradha, Wigg Luisa, Narayana Sumudu K, Lawn Sharon, Muller Kate, Wigg Alan J
Hepatology and Liver Transplantation Medicine Unit, Flinders Medical Centre, Bedford Park, South Australia, Australia
College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.
BMJ Open. 2025 Feb 16;15(2):e089666. doi: 10.1136/bmjopen-2024-089666.
The Australian Liver FaIlurE (ALFIE) trial, a multicentre, randomised controlled trial, assessed the efficacy of a nurse-coordinated model of care to reduce liver-related emergency admissions (LREAs) in patients with decompensated cirrhosis. The model of care was delivered by a specialist nurse, including intensive postdischarge monitoring, linkage to multidisciplinary care, rapid access to care pathway, enhanced education and self-management support.
To examine the experiences of participants and practitioners in the ALFIE trial to understand its impact, barriers and areas for improvement.
A qualitative semistructured interview analysis nested within the ALFIE trial.
A purposeful sample of 15 patients, 14 controls and 12 staff.
Thematic analysis of interview transcripts.
Interventional participants and the nurses perceived the care provided as personalised, holistic and continuous. The intervention enabled the development of robust therapeutic relationships and trust that promoted participant engagement and risk factor modification. It helped intervention participants navigate the busy hospital system. The control participants desired more education and a personal contact to deal with emergencies. With respect to the intervention, nurses felt that their support helped reduce LREAs and improve care, but it was overwhelming. A number of barriers and systemic issues were identified. Suggestions for improvement of the intervention model included increased staffing, improved mental health support and communication pathways with primary care practitioners.
The ALFIE trial was well received by nurses and participants. It met the needs of intervention participants and the health system through easy-to-navigate, personalised, holistic and ongoing care. The study identified barriers and systemic improvement areas.
ACTRN12617001293358.
澳大利亚肝衰竭（ALFIE）试验是一项多中心随机对照试验，评估了护士协调护理模式在减少失代偿期肝硬化患者肝脏相关急诊入院（LREA）方面的疗效。该护理模式由专科护士提供，包括强化出院后监测、与多学科护理的联系、快速进入护理途径、加强教育和自我管理支持。
研究ALFIE试验中参与者和从业者的经历，以了解其影响、障碍和改进领域。
在ALFIE试验中进行定性半结构化访谈分析。
有目的地抽取了15名患者、14名对照者和12名工作人员作为样本。
对访谈记录进行主题分析。
干预组参与者和护士认为所提供的护理是个性化、全面且持续的。该干预措施促进了稳固的治疗关系和信任的建立，从而提高了参与者的参与度并促使其改变危险因素。它帮助干预组参与者应对繁忙的医院系统。对照组参与者希望获得更多教育以及有专人联系以应对紧急情况。关于干预措施，护士们认为他们的支持有助于减少肝脏相关急诊入院并改善护理，但工作量过大。研究还确定了一些障碍和系统性问题。对干预模式改进的建议包括增加人员配备、改善心理健康支持以及与初级保健从业者的沟通途径。
护士和参与者对ALFIE试验反应良好。它通过易于操作、个性化、全面且持续的护理满足了干预组参与者和卫生系统的需求。该研究确定了障碍和系统性改进领域。
ACTRN12617001293358。
