Barriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department
Barriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department
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DOI：
10.1136/emermed-2018-208260
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发表时间：
2019-12-01
影响因子：
3.1
通讯作者：
Cheung, Warren J.
中科院分区：
文献类型：
--
作者：
Parks, Adam;Eagles, Debra;Cheung, Warren J.
背景老年患者通常在跌倒后到艾德就诊。最近的证据表明，艾德医生不遵守已发表的ED特定老年跌倒指南。本研究采用了理论域框架（TDF）的方法，系统地调查的障碍和使能因素，在提供以指南为基础的护理艾德老年fall patients.Methods从2017年6月至9月，半结构化访谈的工作人员艾德医师执业在加拿大安大略，进行了分析。基于TDF的访谈指南被用来捕获14个领域影响提供基于指南的护理。相关领域的频率的信念，存在冲突的信念和证据的强烈信念，将影响提供的指南为基础的care.Results十一个采访进行了执业艾德医生的基础上确定。在13个相关的TDF域中确定了30个信念陈述（除乐观外）。突出的主题包括缺乏知识，缺乏证据，异质性自我感知的技能，感知增加的时间和工作量，专职医疗支持的重要性，不一致的专职医疗工作者，缺乏积极的强化，情绪负面影响这些临床遭遇和支持记忆艾滋病。总体而言，艾德医生支持的指导方针的实施，并认为这将导致更好的结果为老年跌倒patients.Conclusion本研究确定了重要的障碍和使能因素，以提供基于指南的护理在老年艾德跌倒患者。基于这些发现，未来在国内和国际上实施指南应侧重于提高对指南的认识和培训，改善对指南适当管理的积极强化，加强联合健康支持和进一步研究以支持指南。
Background Geriatric patients commonly present to the ED after a fall. Recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric fall guidelines. This study applied a theoretical domains framework (TDF) approach to systematically investigate barriers and enablers in the provision of guideline-based care to ED geriatric fall patients.Methods From June to September 2017, semistructured interviews of staff ED physicians practising in Ontario, Canada, were conducted and analysed. An interview guide based on the TDF was used to capture 14 domains influencing provision of guideline-based care. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs and evidence of strong beliefs that would influence provision of guideline-based care.Results Eleven interviews were conducted with practising ED physicians. Thirty belief statements were identified across 13 relevant TDF domains (all except Optimism). Prominent themes included lack of knowledge, paucity of evidence, heterogeneous self-perceived skills, perceived increased time and workload, importance of allied health support, inconsistently available allied health workers, lack of positive reinforcement, emotions negatively impacting these clinical encounters and support for memory aids. Overall, ED physicians were supportive of guideline implementation, and believe it will lead to better outcomes for geriatric fall patients.Conclusion This study identified important barriers and enablers to provision of guideline-based care in geriatric ED fall patients. Based on these findings, future implementation of guidelines nationally and internationally should focus on improving knowledge and training on guidelines, improving positive reinforcement for guideline-appropriate management, greater allied health support and further research to support guidelines.