Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.
Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care.
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DOI：
10.1136/bmjopen-2017-020521
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发表时间：
2018-03-17
期刊：
影响因子：
2.9
通讯作者：
Bunn F
中科院分区：
文献类型：
--
作者：
Burn AM;Fleming J;Brayne C;Fox C;Bunn F
2012年至2013年，英国国民健康服务（nhs）要求医院在计划外入院的老年人中对痴呆症患者进行系统的病例查找。该方法未定义。本研究的目的是了解目前在英国急性医院发现痴呆病例的方法，并探讨医疗保健专业人员对感知利益和挑战的看法。质性研究包括访谈、焦点小组和专题内容分析。英格兰东部六个郡的初级保健和二级保健。参与痴呆症病例发现的医院工作人员和这些医院集水区的初级保健工作人员。我们招募了23名医院工作人员和36名初级保健工作人员，其中包括30名全科医生。分析得出三个主题：(1)病例发现过程中缺乏一致的方法；(2)影响病例发现结果的初级保健和二级保健之间的障碍；(3)对病例发现的理由、目标和影响的看法。研究表明，医院记录和向全科医生报告结果的情况各不相同。初级保健和二级保健之间的障碍，包括全科医生无法获得医院调查和缺乏明确的角色和责任，影响了发现病例的结果。二级保健工作人员比初级保健工作人员对这一举措更为积极，而且在发现病例方面，初级保健和二级保健的优先事项存在冲突。该研究表明，需要一种更循证的方法来证明痴呆症病例发现方法的合理性。在全科医生能够有效规划进一步的调查、治疗或护理之前，从医院传达给初级保健的信息需要全面、适当和一致。初级保健的随访进一步要求获得诊断后支持的选择。有必要评估患者的结果以及各种环境对卫生和保健服务的经济影响。
In 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges. Qualitative study involving interviews, focus groups and thematic content analysis. Primary care and secondary care across six counties in the East of England. Hospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals. We recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding. The study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.
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影响因子：
4.1
作者：
Martin S;Fleming J;Cullum S;Dening T;Rait G;Fox C;Katona C;Brayne C;Lafortune L
通讯作者：
Lafortune L
影响因子：
6.7
作者：
Jackson, Thomas A.;MacLullich, Alasdair M. J.;Sheehan, Bart
通讯作者：
Sheehan, Bart
影响因子：
6.7
作者：
Collins, Noel;Blanchard, Martin R.;Sampson, Elizabeth L.
通讯作者：
Sampson, Elizabeth L.
影响因子：
15.8
作者：
Jackson TA;Gladman JR;Harwood RH;MacLullich AM;Sampson EL;Sheehan B;Davis DH
通讯作者：
Davis DH
影响因子：
2.6
作者：
Fox, C.;Lafortune, L.;Brayne, C.
通讯作者：
Brayne, C.