Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management: Barrier Identification and Implementation Strategy Mapping.
Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management: Barrier Identification and Implementation Strategy Mapping.
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DOI：
10.2147/jmdh.s282308
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发表时间：
2020
影响因子：
3.3
通讯作者：
Hardy J
中科院分区：
文献类型：
--
作者：
Delaforce A;Duff J;Munday J;Hardy J
接受大手术的患者有大量失血和输血的风险，如果他们有预先存在的贫血，这会大大增加。术前贫血和缺铁筛查、评估和管理途径（PAIDSEM-P）概述了推荐的血液检查和治疗，以优化术前患者。使用PAIDSEM-P减少输血和改善患者结局的成功记录存在，但此类研究的报告质量不佳。目前还不清楚什么样的实施战略最好地支持PAIDSEM-P的实施。最大的变化，有目的的抽样被用来招募共15名参与者，包括一系列的卫生专业人员和病人的半结构化面试。数据分析采用演绎法，根据实施研究综合框架（CFIR）确定障碍，并根据实施变革专家建议（ERIC）报告建议的实施战略。行动、行动者、背景、目标和时间框架的修改版本有助于概念化和有针对性的战略选择。分析发现了五个障碍：获得知识和信息、患者需求和资源、关于干预措施的知识和信念、可用资源以及网络和通信，这些都有ERIC的强烈建议，包括召开教育会议、编写教育材料、分发教育材料、获取和使用患者/消费者家庭反馈、让患者/消费者/家庭成员参与、进行当地需求评估，获得新的资金，促进网络编织，并组织临床医生实施团队会议。映射的障碍和策略，使用ERIC框架的基础上，个别演员类别被证明是有用的，在确定一个务实的实施策略，可能有助于支持利用PAIDSEM-P和其他循证医疗实施问题更广泛。
Patients undergoing major surgery risk significant blood loss and transfusion, which increases substantially if they have pre-existing anemia. Preoperative Anemia and Iron Deficiency Screening, Evaluation and Management Pathways (PAIDSEM-P) outline recommended blood tests and treatment to optimize patients before surgery. Documented success using PAIDSEM-P to reduce transfusions and improve patient outcomes exists, but the reporting quality of such studies is suboptimal. It remains unclear what implementation strategies best support the implementation of PAIDSEM-P. Maximum variation, purposive sampling was used to recruit a total of 15 participants, including a range of health professionals and patients for semi-structured interviews. Data analysis utilized a deductive approach informed by the Consolidated Framework for Implementation Research (CFIR) for barrier identification and the Expert Recommendations for Implementing Change (ERIC) for reporting recommended implementation strategies. A modified version of the Action, Actor, Context, Target and Time (AACTT) framework assisted with conceptualisation and targeted strategy selection. The analysis revealed five barriers: access to knowledge and information, patient needs and resources, knowledge and beliefs about the intervention, available resources, and networks and communications, which had strong ERIC recommendations, including conduct educational meetings, develop educational materials, distribute educational materials, obtain and use patients/consumers family feedback, involve patients/consumers/family members, conduct a local needs assessment, access new funding, promote network weaving, and organize clinician implementation team meetings. Mapping the barriers and strategies using the ERIC framework on the basis of individual actor categories proved to be useful in identifying a pragmatic number of implementation strategies that may help in supporting the utilisation of the PAIDSEM-P and other evidence-based healthcare implementation problems more broadly.