Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation
Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation
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DOI：
10.1186/1472-6963-8-274
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发表时间：
2008-12-23
影响因子：
2.8
通讯作者：
Jones, Roger
中科院分区：
文献类型：
--
作者：
Byng, Richard;Norman, Ian;Jones, Roger
背景：复杂的干预措施的组成部分在不同的情况下可能会有所不同。使用现实评估框架，本研究调查了复杂的卫生服务干预如何导致长期精神疾病患者共享护理的发展。方法：在随机对照试验的同时，进行回顾性定性访谈研究。由促进者支持的多方面干预旨在发展共享护理系统。这项研究是在伦敦进行的。参与者包括来自12个参与的初级卫生保健团队及其相关社区精神卫生团队的46名从业者和管理人员。访谈的重点是如何和为什么得到结果，并使用一个结合了背景和干预机制的框架进行分析。结果：完成了31次访谈，创建了12个案例研究。询问强调了促进进程的催化、开展和审查职能的重要性。干预的其他方面不那么占主导地位。干预几乎在所有实践中都促进了联系工人和联络安排的分配。LINK工作人员和全科医生之间的病例讨论改善了个人护理，并帮助LINK工作人员成为初级保健团队的一部分；但持续融入团队取决于LINK工作人员的灵活性和经验，以及选择相关患者进行病例讨论。促进者的工作职能包括建议，有时还包括人力，以帮助引入成功的系统来审查护理，但花费在开发IT系统上的时间很少有成效。干预的回顾功能较弱，有时无法解决联络或回忆发展中的问题。结论：在危机时刻进行个案讨论和改善联络，而不是主动回忆，是共享关怀的关键功能，有助于心理健康链接的成功。这种多方面的干预通过催化和行动产生了最大的影响，而促进的审查功能较弱，其他因素被认为不那么重要。真实评估通过允许具体关注背景，为这一过程评估提供了有用的理论框架。尽管复杂的干预措施可能看起来“失控”，但由于其在不同情况下的不同表现形式，背景敏感的过程评估可以帮助确定干预措施的关键功能。
Background: Complex interventions have components which can vary in different contexts. Using the Realistic Evaluation framework, this study investigates how a complex health services intervention led to developments in shared care for people with long-term mental illness.Methods: A retrospective qualitative interview study was carried out alongside a randomised controlled trial. The multi-faceted intervention supported by facilitators aimed to develop systems for shared care. The study was set in London. Participants included 46 practitioners and managers from 12 participating primary health care teams and their associated community mental health teams. Interviews focussed on how and why out comes were achieved, and were analysed using a framework incorporating context and intervening mechanisms.Results: Thirty-one interviews were completed to create 12 case studies. The enquiry highlighted the importance of the catalysing, doing and reviewing functions of the facilitation process. Other facets of the intervention were less dominant.The intervention catalysed the allocation of link workers and liaison arrangements in nearly all practices. Case discussions between link workers and GPs improved individual care as well as helping link workers become part of the primary care team; but sustained integration into the team depended both on flexibility and experience of the link worker, and upon selection of relevant patients for the case discussions. The doing function of facilitators included advice and, at times, manpower, to help introduce successful systems for reviewing care, however time spent developing IT systems was rarely productive. The reviewing function of the intervention was weak and sometimes failed to solve problems in the development of liaison or recall.Conclusion: Case discussions and improved liaison at times of crisis, rather than for proactive recall, were the key functions of shared care contributing to the success of Mental Health Link. This multifaceted intervention had most impact through catalysing and doing, whereas the reviewing function of the facilitation was weak, and other components were seen as less important.Realistic Evaluation provided a useful theoretical framework for this process evaluation, by allowing a specific focus on context. Although complex interventions might appear 'out of control', due to their varied manifestation in different situations, context sensitive process evaluations can help identify the intervention's key functions.