Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice.
Integrating clinician support with intervention design as part of a programme testing stratified care for musculoskeletal pain in general practice.
复制标题
DOI：
10.1186/s12875-021-01507-8
复制
发表时间：
2021-07-26
影响因子：
2.9
通讯作者：
Cooper V
中科院分区：
文献类型：
--
作者：
Protheroe J;Saunders B;Hill JC;Chudyk A;Foster NE;Bartlam B;Wathall S;Cooper V
分层护理涉及根据关键特征（如预后风险）对患者进行亚组，并将这些亚组与早期治疗方案相匹配。STartT-MSK项目开发并测试了一种新的分层初级保健干预措施，用于一般实践中常见肌肉骨骼（MSK）疾病的患者。分层护理涉及改变全科医生（GP）的行为，远离目前的“阶梯式”护理方法，以确定与患者持续疼痛风险相匹配的早期治疗方案。改变医疗实践是具有挑战性的，为了帮助成功提供分层护理，需要对全科医生进行教育和支持。本文详细介绍了迭代开发的临床医生支持包在整个生命周期的程序，以支持全科医生提供分层护理干预。我们认为，临床医生的支持是干预本身的一个重要方面，这往往被忽视。定性研究与患者和全科医生确定的障碍和促进因素，通过分层护理，这是映射到理论领域框架（TDF）。确定的领域被“翻译”成一个教育范例，并开发了一个支持包的初始版本。在可行性和试点随机对照试验之后，这一点得到了进一步完善，并为主要随机对照试验制定了最后的一揽子支持计划。临床医生支持包包括面对面的会议相结合的成人学习原则与行为改变理论的多方法的方法，其中包括小组讨论，模拟咨询，病人的小插曲和模型咨询视频。对全科医生的结构化支持对于促进忠诚和最终成功的试验至关重要。临床医生支持是一个双向过程-研究团队可以学习和适应先前未发现的特定本地因素和问题。需要高级临床医生的支持，以确保“买进”。监测全科医生的表现，提供定期反馈和补救支持是有效的临床医生支持的重要方面。从试验干预设计开始，以循证、理论为基础的方式设计有效的临床医生支持，对于鼓励试验中的积极参与和干预保真度至关重要，从而能够提供稳健可靠的原理验证试验。我们为未来的一般实践干预提供了实用的建议。
Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to early treatment options. The STarT-MSK programme developed and tested a new stratified primary care intervention for patients with common musculoskeletal (MSK) conditions in general practice. Stratified care involves changing General Practitioners’ (GPs) behaviour, away from the current ‘stepped’ care approach to identifying early treatment options matched to patients’ risk of persistent pain. Changing healthcare practice is challenging, and to aid the successful delivery of stratified care, education and support for GPs was required. This paper details the iterative development of a clinician support package throughout the lifespan of the programme, to support GPs in delivering the stratified care intervention. We argue that clinician support is a crucial aspect of the intervention itself, which is often overlooked. Qualitative research with patients and GPs identified barriers and facilitators to the adoption of stratified care, which were mapped onto the Theoretical Domains Framework (TDF). Identified domains were ‘translated’ into an educational paradigm, and an initial version of the support package developed. This was further refined following a feasibility and pilot RCT, and a finalised support package was developed for the main RCT. The clinician support package comprised face-to-face sessions combining adult-learning principles with behaviour change theory in a multimethod approach, which included group discussion, simulated consultations, patient vignettes and model consultation videos. Structured support for GPs was crucial to facilitate fidelity and, ultimately, a successful trial. Clinician support is a two-way process– the study team can learn from and adapt to specific local factors and issues not previously identified. The support from senior clinicians was required to ensure ‘buy in’. Monitoring of GP performance, provision of regular feedback and remedial support are important aspects of effective clinician support. Designing effective clinician support from the onset of trial intervention design, in an evidence-based, theory-informed manner, is crucial to encourage active engagement and intervention fidelity within the trial, enabling the delivery of a robust and reliable proof-of-principle trial. We offer practical recommendations for future general practice interventions.
登录
查看更多内容
DOI：
10.1136/bmj.h1258
发表时间：
2015-03-19
期刊：
BMJ (Clinical research ed.)
影响因子：
--
作者：
Moore GF;Audrey S;Barker M;Bond L;Bonell C;Hardeman W;Moore L;O'Cathain A;Tinati T;Wight D;Baird J
通讯作者：
Baird J
影响因子：
2.3
作者：
Protheroe, Joanne;Saunders, Benjamin;Foster, Nadine E.
通讯作者：
Foster, Nadine E.
影响因子：
0.9
作者：
Gallagher, Gina;Bell, Alison
通讯作者：
Bell, Alison
影响因子：
9.3
作者：
Sanders, Tom;Foster, Nadine E.;Ong, Bie Nio
通讯作者：
Ong, Bie Nio
影响因子：
1.7
作者：
Hill, Jonathan;Garvin, Stefannie;Foster, Nadine E.
通讯作者：
Foster, Nadine E.