Understanding the implementation of 'sick day guidance' to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation.
Understanding the implementation of 'sick day guidance' to prevent acute kidney injury across a primary care setting in England: a qualitative evaluation.
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DOI：
10.1136/bmjopen-2017-017241
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发表时间：
2017-11-08
期刊：
影响因子：
2.9
通讯作者：
Blakeman T
中科院分区：
文献类型：
--
作者：
Martindale AM;Elvey R;Howard SJ;McCorkindale S;Sinha S;Blakeman T
该研究旨在检验初级保健机构中旨在预防急性肾损伤 (AKI) 的病假指导卡的实施情况。进行了定性半结构化访谈，并根据标准化过程理论进行了比较分析，以了解卡片及相关指导的意义构建、实施和评估。英格兰北部的单一初级保健医疗机构。 29 名参与者参加了定性评估：7 名全科医生、5 名执业护士、5 名社区药剂师、4 名执业药剂师、2 名管理人员、1 名医疗助理和 5 名患者。病假指导干预措施在全科诊所 (n=48) 和社区药房 (n=60) 中推出（2015-2016 年）。这些材料包括一张“药物病假指导”卡，提供给正在服用所列药物的患者。该卡提供了急性疾病发作期间药物管理的建议。向医疗保健从业者和管理人员提供了一份信息传单，建议如何使用和发放卡片。实施病假指导卡以预防 AKI 需要在初级保健中采取一套新的工作实践。确保对高危人群进行卡片管理，同时有信心确保患者了解卡片的目的和用途，两者之间存在着紧张关系。传达暂时停止用药的概念是一个特殊的挑战，并且限制了 AKI 风险较高的患者群体的用药，特别是那些自我管理能力较差的患者。如果没有足够的资源或作为独立干预措施提供，仅关注药物管理的病假指导卡可能对患者的益处有限。迫切需要制定和评估初级保健干预措施，以解决 AKI 相关的危害。
The study sought to examine the implementation of sick day guidance cards designed to prevent acute kidney injury (AKI), in primary care settings. Qualitative semistructured interviews were conducted and comparative analysis informed by normalisation process theory was undertaken to understand sense-making, implementation and appraisal of the cards and associated guidance. A single primary care health setting in the North of England. 29 participants took part in the qualitative evaluation: seven general practitioners, five practice nurses, five community pharmacists, four practice pharmacists, two administrators, one healthcare assistant and five patients. The sick day guidance intervention was rolled out (2015–2016) in general practices (n=48) and community pharmacies (n=60). The materials consisted of a ‘medicine sick day guidance’ card, provided to patients who were taking the listed drugs. The card provided advice about medicines management during episodes of acute illness. An information leaflet was provided to healthcare practitioners and administrators suggesting how to use and give the cards. Implementation of sick day guidance cards to prevent AKI entailed a new set of working practises across primary care. A tension existed between ensuring reach in administration of the cards to at risk populations while being confident to ensure patient understanding of their purpose and use. Communicating the concept of temporary cessation of medicines was a particular challenge and limited their administration to patient populations at higher risk of AKI, particularly those with less capacity to self-manage. Sick day guidance cards that focus solely on medicines management may be of limited patient benefit without adequate resourcing or if delivered as a standalone intervention. Development and evaluation of primary care interventions is urgently warranted to tackle the harm associated with AKI.
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影响因子：
2.9
作者：
Morris RL;Ashcroft D;Phipps D;Bower P;O'Donoghue D;Roderick P;Harding S;Lewington A;Blakeman T
通讯作者：
Blakeman T
影响因子：
4.6
作者：
Kanagasundaram, Nigel S.;Bevan, Mark T.;Sheerin, Neil S.
通讯作者：
Sheerin, Neil S.
影响因子：
7.2
作者：
May, Carl R.;Mair, Frances;Montori, Victor M.
通讯作者：
Montori, Victor M.
影响因子：
5.5
作者：
通讯作者：
--
影响因子：
6.1
作者：
Kerr, Marion;Bedford, Michael;O'Donoghue, Donal
通讯作者：
O'Donoghue, Donal