Preventing Acute Kidney Injury: a qualitative study exploring 'sick day rules' implementation in primary care.
Preventing Acute Kidney Injury: a qualitative study exploring 'sick day rules' implementation in primary care.
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DOI：
10.1186/s12875-016-0480-5
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发表时间：
2016-07-22
影响因子：
2.9
通讯作者：
Blakeman T
中科院分区：
文献类型：
--
作者：
Morris RL;Ashcroft D;Phipps D;Bower P;O'Donoghue D;Roderick P;Harding S;Lewington A;Blakeman T
为了应对日益增长的紧急护理服务需求，有必要在初级保健中实施更有效的战略，以支持具有复杂护理需求的患者。通过实施“病假规则”（即暂时停药）来改善肾脏健康的初级保健管理，以预防急性肾损伤（阿基），有可能解决一个主要的患者安全问题，并减少计划外住院。本研究的目的是检查过程中，可能会启用或限制实施“病假规则”的阿基预防到日常护理提供初级保健。40个半结构化的访谈进行了与3期慢性肾脏疾病患者和有目的地抽样，全科医生，执业护士和社区药剂师，无论是谁，或没有，实施“病假规则”。标准化过程理论被用作数据收集和分析的框架。参与者倾向于表达对病假规则的最初热情，以防止阿基，这与提供全面护理相吻合。然而，考虑到影响其执行的因素，人们的兴趣往往会减少。这些包括服务内部和跨服务的参与;临床信息的一致性;以及可用于实施的资源。参与者发现，支持患有多种疾病的患者，特别是慢性心力衰竭患者，使定制计划变得复杂。将阿基倡议实施到常规实践中需要适当的资源以及在当地为患者和临床医生提供培训支持，以支持系统重新设计。本文的在线版本（doi：10.1186/s12875-016-0480-5）包含补充材料，可供授权用户使用。
In response to growing demand for urgent care services there is a need to implement more effective strategies in primary care to support patients with complex care needs. Improving primary care management of kidney health through the implementation of ‘sick day rules’ (i.e. temporary cessation of medicines) to prevent Acute Kidney Injury (AKI) has the potential to address a major patient safety issue and reduce unplanned hospital admissions. The aim of this study is to examine processes that may enable or constrain the implementation of ‘sick day rules’ for AKI prevention into routine care delivery in primary care. Forty semi-structured interviews were conducted with patients with stage 3 chronic kidney disease and purposefully sampled, general practitioners, practice nurses and community pharmacists who either had, or had not, implemented a ‘sick day rule’. Normalisation Process Theory was used as a framework for data collection and analysis. Participants tended to express initial enthusiasm for sick day rules to prevent AKI, which fitted with the delivery of comprehensive care. However, interest tended to diminish with consideration of factors influencing their implementation. These included engagement within and across services; consistency of clinical message; and resources available for implementation. Participants identified that supporting patients with multiple conditions, particularly with chronic heart failure, made tailoring initiatives complex. Implementation of AKI initiatives into routine practice requires appropriate resourcing as well as training support for both patients and clinicians tailored at a local level to support system redesign. The online version of this article (doi:10.1186/s12875-016-0480-5) contains supplementary material, which is available to authorized users.