Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV
Implementation barriers and facilitators of an integrated multidisciplinary lifestyle enhancing treatment for inpatients with severe mental illness: the MULTI study IV
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DOI：
10.1186/s12913-019-4608-x
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发表时间：
2019-10-22
影响因子：
2.8
通讯作者：
van Harten, Peter N.
中科院分区：
文献类型：
--
作者：
Deenik, Jeroen;Tenback, Diederik E.;van Harten, Peter N.
尽管越来越多的研究表明生活方式干预在改善严重精神疾病（SMI）患者不良健康结局方面的疗效，但常规实施仍然是临时性的。最近，在荷兰的一家长期住院机构，作为常规护理的一部分，对SMI（MULTI）住院患者实施了多学科生活方式改善治疗，18个月后健康状况显著改善。目前的研究旨在查明执行该战略的障碍和促进因素。方法与MULTI的实施，有关的创新，用户（患者，医疗保健专业人员（HCP）），和组织的背景下，相关的决定因素进行了评估，在三个病房，提供MULTI。创新决定因素的循证测量工具用于评估决定因素（29项），每项都通过5分制李克特量表和其他开放式问题进行测量。我们认为，>= 20%的HCP或患者的负面反应（“完全不同意/不同意”，评分< 3）是障碍，>= 80%的HCP或患者的正面反应（“同意/完全同意”，评分> 3）是促进因素。如果主题由≥ 2名HCP或患者提及，则我们纳入了对开放式问题的回答。共邀请50名HCP（在线问卷）和46名患者（半结构化访谈）参与研究。结果参与的HCP（n = 42）提到组织因素是最大的障碍（例如组织变化和财政资源）。患者（n = 33）提到参与MULTI的复杂性是主要障碍，部分原因可能是组织因素（例如，护士没有时间改进剪裁）。HCP和患者对MULTI的积极态度促进了实施，包括他们自己在其中的作用。HCP和患者的公开回应显示出对MULTI的强烈承诺，合作和所有权。结论：这是第一项分析在常规临床护理中针对重度精神病住院患者实施务实的生活方式干预的研究。HCP和患者对这种方法的积极态度促进了MULTI的实施。我们建议需要制定解决组织实施障碍的策略，以进一步改善和维持MULTI，从而成功地为重度精神分裂症住院患者实现积极的健康相关结果。
Background Despite an increase in studies showing the efficacy of lifestyle interventions in improving the poor health outcomes for people with severe mental illness (SMI), routine implementation remains ad hoc. Recently, a multidisciplinary lifestyle enhancing treatment for inpatients with SMI (MULTI) was implemented as part of routine care at a long-term inpatient facility in the Netherlands, resulting in significant health improvements after 18 months. The current study aimed to identify barriers and facilitators of its implementation. Methods Determinants associated with the implementation of MULTI, related to the innovation, the users (patients, the healthcare professionals (HCPs)), and the organisational context, were assessed at the three wards that delivered MULTI. The evidence-based Measurement Instrument for Determinants of Innovations was used to assess determinants (29 items), each measured through a 5-point Likert scale and additional open-ended questions. We considered determinants to which >= 20% of the HCPs or patients responded negatively ("totally disagree/disagree", score < 3) as barriers and to which >= 80% of HCPs or patients responded positively ("agree/totally agree", score > 3) as facilitators. We included responses to open-ended questions if the topic was mentioned by >= 2 HCPs or patients. In total 50 HCPs (online questionnaire) and 46 patients (semi-structured interview) were invited to participate in the study. Results Participating HCPs (n = 42) mentioned organisational factors as the strongest barriers (e.g. organisational changes and financial resources). Patients (n = 33) mentioned the complexity of participating in MULTI as the main barrier, which could partly be due to organisational factors (e.g. lack of time for nurses to improve tailoring). The implementation was facilitated by positive attitudes of HCPs and patients towards MULTI, including their own role in it. Open responses of HCPs and patients showed strong commitment, collaboration and ownership towards MULTI. Conclusions This is the first study analysing the implementation of a pragmatic lifestyle intervention targeting SMI inpatients in routine clinical care. Positive attitudes of both HCPs and patients towards such an approach facilitated the implementation of MULTI. We suggest that strategies addressing organisational implementation barriers are needed to further improve and maintain MULTI, to succeed in achieving positive health-related outcomes in inpatients with SMI.