Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals.
Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals.
复制标题
痴呆症和合并症患者的医疗组织和分娩：一项定性研究，探讨了患者，护理人员和专业人士的观点。
DOI：
10.1136/bmjopen-2016-013067
复制
发表时间：
2017-01-18
期刊：
影响因子：
2.9
通讯作者：
Goodman C
中科院分区：
文献类型：
--
作者：
Bunn F;Burn AM;Robinson L;Poole M;Rait G;Brayne C;Schoeman J;Norton S;Goodman C
痴呆症患者 (PLWD) 合并症的患病率很高。本研究的目的是探讨痴呆症对获得非痴呆症服务的影响，并确定改善该人群服务提供的方法。涉及访谈和焦点小组的定性研究。主题内容分析以护理连续性和获得护理的理论为依据。英格兰南部和东北部的初级和二级护理。患有以下 1 种合并症的 PLWD：糖尿病、中风、视力障碍，其家庭护理人员和医疗保健专业人员 (HCP) 患有这 3 种病症。我们招募了 28 名社区居住的 PLWD、33 名家庭护理人员和 56 名 HCP。分析得出 3 个总体主题：(1) 家庭护理人员促进获得护理和护理的连续性，(2) 痴呆症的严重程度和表现对共病管理的影响，(3) 跨专业和服务的沟通和协作没有意识到痴呆症。我们找到了良好实践的例子，但这些往往是关于个体从业者的行为，而不是基于系统的方法；当前的系统可能会无意中阻止对 PLWD 的护理。这项研究表明，为了改善 PLWD 和合并症的可及性和连续性，需要对护理组织进行重大改变，其中包括： 专业人士、 PLWD 和家庭护理人员合作提供护理；认识到患者的痴呆症诊断会影响其他长期疾病的治疗；服务的灵活性，以确保他们对残疾人及其家庭护理人员随着时间的推移不断变化的需求保持敏感；并改善跨专业和组织的协作。需要进行研究来制定干预措施，支持合作伙伴关系工作以及针对 PLWD 和合并症的护理定制。
People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population. Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care. Primary and secondary care in the South and North East of England. PLWD who had 1 of the following comorbidities—diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions. We recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity.