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首页> 外文期刊>Implementation Science >Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience
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Using behavioural theories to optimise shared haemodialysis care: a qualitative intervention development study of patient and professional experience

机译：使用行为理论优化共享血液透析护理：针对患者和专业经验的定性干预发展研究

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Background Patients in control of their own haemodialysis report better outcomes than those receiving professional controlled care in a hospital setting, even though home and hospital haemodialysis are largely equivalent from mechanical and physiological perspectives. Shared Haemodialysis Care (SHC) describes an initiative in which hospital haemodialysis patients are supported by dialysis staff to become as involved as they wish in their own care; and can improve patient safety, satisfaction and may reduce costs. We do not understand why interventions to support self-management in other conditions have variable effects or how to optimise the delivery of SHC. The purpose of this study was to identify perceived patient and professional (nurses and healthcare assistants) barriers to the uptake of SHC, and to use these data to identify intervention components to optimise care. Methods Individual semi-structured interviews with patients and professionals were conducted to identify barriers and facilitators. Data were coded to behavioural theory to identify solutions. A national UK learning event with multiple stakeholders (patients, carers, commissioners and professionals) explored the salience of these barriers and the acceptability of solutions. Results A complex intervention strategy was designed to optimise SHC for patients and professionals. Interviews were conducted with patients (n?=?15) and professionals (n?=?7) in two hospitals and three satellite units piloting SHC. Data from patient and professional interviews could be coded to behavioural theory. Analyses identified key barriers (knowledge, beliefs about capabilities, skills and environmental context and resources). An intervention strategy that focuses on providing, first, patients with information about the shared nature of care, how to read prescriptions and use machines, and second, providing professionals with skills and protected time to teach both professionals/patients, as well as providing continual review, may improve the implementation of SHC and be acceptable to stakeholders. Conclusions We have developed an intervention strategy to improve the implementation of SHC for patients and professionals. While this intervention strategy has been systematically developed using behavioural theory, it should be rigorously tested in a subsequent effectiveness evaluation study prior to implementation to ensure that shared haemodialysis care can be delivered equitably, efficiently and safely for all patients.
机译：背景技术尽管在机械和生理方面，家庭和医院的血液透析在很大程度上与之相当，但控制自己的血液透析的患者的结局要比在医院中接受专业控制的患者更好。共享血液透析护理（SHC）描述了一项倡议，其中医院的血液透析患者由透析人员支持，使其如愿以偿地参与他们自己的护理;并可以提高患者的安全性，满意度并可以降低成本。我们不明白为什么在其他情况下支持自我管理的干预措施会产生不同的影响，或者如何优化SHC的提供。这项研究的目的是确定患者和专业人士（护士和保健助理）摄取SHC的障碍，并使用这些数据来确定干预措施以优化护理。方法对患者和专业人员进行半结构式访谈，以找出障碍和促进者。将数据编码为行为理论以识别解决方案。一项由多个利益相关者（患者，护理人员，专员和专业人员）组成的英国国家学习活动探讨了这些障碍的严重性和解决方案的可接受性。结果设计了一种复杂的干预策略，以优化患者和专业人员的SHC。在两家试点SHC的医​​院和三个卫星单位对患者（n = 15）和专业人员（n = 7）进行了访谈。来自患者和专业访谈的数据可以编码为行为理论。分析确定了主要障碍（知识，对能力，技能，环境背景和资源的信念）。一种干预策略，其重点是首先为患者提供有关护理的共同性质，如何阅读处方和使用机器的信息，其次为专业人员提供技能和受保护的时间来教导专业人员/患者，以及提供持续的服务。审查，可以改善SHC的实施，并为利益相关者所接受。结论我们制定了一项干预策略，以改善患者和专业人员对SHC的实施。尽管已使用行为理论系统地开发了这种干预策略，但在实施之前应在随后的有效性评估研究中对其进行严格测试，以确保可以为所有患者公平，有效和安全地提供共享的血液透析护理。

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