A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department.
A Survey-Based Needs Assessment of Barriers to Optimal Sickle Cell Disease Care in the Emergency Department.
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DOI：
10.1016/j.annemergmed.2020.08.013
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发表时间：
2020-09
影响因子：
6.2
通讯作者：
Sickle Cell Disease Implementation Consortium
中科院分区：
文献类型：
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作者：
Linton EA;Goodin DA;Hankins JS;Kanter J;Preiss L;Simon J;Souffront K;Tanabe P;Gibson R;Hsu LL;King A;Richardsona LD;Glassberg JA;Sickle Cell Disease Implementation Consortium
在实施科学框架的指导下，该需求评估确定了急诊科（ED）治疗镰状细胞病（SCD）的机构、提供者和患者层面的障碍，为多中心镰状细胞病实施联盟（SCDIC）开展的未来干预提供信息。SCDIC开发并实施了一项有效的需求评估调查，对SCD患者和ED护理人员进行了横断面方便样本管理。共有来自美国7个和5个地区的516名患有SCD的青少年和成人以及243名ED提供者对SCD的ED护理服务进行了调查。调查结果显示，84.5%的SCD受访者有一个门诊医生，他治疗了许多SCD患者。在急诊科，54.3%的人认为没有得到足够快的护理，46.0%的人认为医生不关心他们，护士也有类似的情况（34.9%）。因此，48.6%的人对他们的急诊科护理“从不”或“有时”满意。在接受调查的ED提供者中，75.1%的人不知道国家心肺血液研究所对血管闭塞危像的建议，但98.1%的人对他们护理SCD患者的知识充满信心。ED提供者认为以下因素是护理管理的障碍：“阿片类药物流行”（62.1%），“患者行为”（60.9%），“过度拥挤”（58.0%），“对成瘾的担忧”（47.3%）和“隐性偏见”（37.0%）。结果强调，许多SCD患者对他们的ED护理不满意，并突出了在实践、提供者和患者层面上对最佳护理的挑战。探索这些差异可能有助于改善急诊科护理。
Guided by an implementation science framework, this needs assessment identifies institutional, provider, and patient-level barriers to care of Sick Cell Disease (SCD) in the Emergency Department (ED) to inform future interventions conducted by the multi-center Sickle Cell Disease Implementation Consortium (SCDIC). The SCDIC developed and implemented a validated needs assessment survey administered to a cross-sectional convenience sample of patients with SCD and ED providers caring for them. In total, 516 adolescents and adults with SCD and 243 ED providers from seven and five regions of the US, respectively, responded to the ED care delivery for SCD survey. Survey results demonstrated that 84.5% of respondents with SCD have an outpatient provider who treats many patients with SCD. In the ED, 54.3% reported not getting care fast enough and 46.0% believed physicians did not care about them and similarly of nurses (34.9%). Consequently, 48.6% were “never” or “sometimes” satisfied with their ED care. Of surveyed ED providers, 75.1% were unaware of the National Heart, Lung, and Blood Institute recommendations for vaso-occlusive crises, yet 98.1% were confident in their knowledge to care for patients with SCD. ED providers identified the following factors as barriers to care administration: “opioid epidemic” (62.1%), “patient behavior” (60.9%), “overcrowding” (58.0%), “concern about addiction” (47.3%) and “implicit bias” (37.0%). The results underscore that many patients with SCD are dissatisfied with their ED care and highlight challenges to optimal care on the practice, provider and patient levels. Exploring these differences may facilitate improvements in ED care.