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首页> 外文期刊>BMC Health Services Research >Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV
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Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV

机译：综合性多学科生活方式增强严重精神疾病住院患者治疗的实施障碍和促进因素：MULTI研究IV

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Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18?months. The current study aimed to identify barriers and facilitators of its implementation. Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which ≥20% of the HCPs or patients responded negatively (“totally disagree/disagree”, score 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by ≥2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. Participating HCPs (n?=?42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n?=?33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.
机译：尽管有越来越多的研究表明生活方式干预可以改善严重精神疾病（SMI）患者的不良健康结果，但常规实施仍是临时性的。最近，在荷兰的一个长期住院设施中，作为常规护理的一部分，对SMI住院患者实施了多学科的生活方式增强治疗（MULTI），从而在18个月后显着改善了健康状况。当前的研究旨在查明其实施的障碍和促进者。在提供MULTI的三个病房中评估了与MULTI实施相关的决定因素，这些决定涉及创新，用户（患者，医护人员（HCP））和组织环境。基于证据的创新决​​定因素衡量工具用于评估决定因素（29个项目），每个因素均通过5点李克特量表和其他开放式问题进行衡量。我们考虑的决定因素是≥20％的HCP或患者对治疗有否定反应（“完全不同意/不同意”，评分3）。如果该主题被≥2个HCP或患者提及，我们包括对开放式问题的回答。总共邀请了50位HCP（在线问卷）和46位患者（半结构化访谈）参加了该研究。参与的HCP（n？=？42）提到组织因素是最大的障碍（例如组织变革和财务资源）。患者（n？=？33）提到参加MULTI是主要障碍，这可能部分是由于组织因素（例如，护士缺乏时间来改善剪裁）。 HCP和患者对MULTI的积极态度（包括他们在其中的作用）促进了实施。 HCP和患者的公开回应显示出对MULTI的坚定承诺，合作和主人翁精神。这是第一项针对常规临床护理中针对SMI住院患者的实用生活方式干预措施的实施情况进行的研究。 HCP和患者对这种方法的积极态度促进了MULTI的实施。我们建议，需要针对组织实施障碍的策略来进一步改善和维持MULTI，以成功实现SMI住院患者的健康相关积极结果。

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