Enhanced integration of primary and secondary health systems and patient empowerment through improved continuity of patient care and clinical handover

通过改善患者护理和临床移交的连续性，加强初级和二级卫生系统的整合以及患者赋权

• 批准号: MR/M00287X/1
• 负责人: Semira Manaseki-Holland
• 金额: $ 12.98万
• 依托单位: University of Birmingham
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2014
• 资助国家: 英国
• 起止时间: 2014 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FM00287X%2F1
• 关键词: Enhanced; integration; primary; secondary; health

Effective integration of care between community (primary) and hospital care (secondary) health services is essential for a patient whose needs extend beyond the initial episode, and more care is required by the next level of health provider. This may include referral to a hospital if a primary care doctor cannot manage the condition or the continuation of medication and check-ups in the primary care after a hospital admission. The crucial stage is communication of patient-specific information from one caregiver to another or to the patient and family, for the purpose of ensuing patient care continuity and safety, termed clinical handover. A review of evidence in the high-income countries showed that the consequences of ineffective handover led to incorrect treatment, delays in medical diagnosis, life-threatening adverse events, patient complaints, increased health care expenditure, increased length of stay, increased re-admissions, and other impacts on health systems. Although we have not been able to find similar data for LMIC, experience and discussions with partners and experts indicate that the rate of adverse events and other unwanted outcomes due to poor handover are even greater in LMICs due to huge gaps in integration of health providers. It is likely therefore, that considerable scope exists to improve practice in a way that is cost-effective and potentially even cost releasing. These may be adapted from methods that have been successfully implemented in high-income countries (e.g. check-lists, patient held records). There is a global focus from the WHO on health systems development, critical for a better response to challenges of emergencies, infectious and other diseases. The rise in elderly populations and deteriorating lifestyle behaviours (e.g. smoking rates) in LMICs have increased the burden of heart related, diabetes and other long term diseases. Due to their need for on-going care, these are particularly adversely affected by poor integration between primary and secondary care. Thus the main drivers for our proposal are evidence for the following: -clinical handover processes are at the core of patient safety and consequences of inadequate clinical handover result in poor patient outcome and high cost to the health system- Clinical handover is a global priority identified by the WHO Patient Safety Programme. There is need and interest in many LMICs to improve integration between-levels of health care, but little evidence to guide local decision makers in how to identify and overcome barriers to improved practice -initial interventions can be culturally and politically acceptable, affordable and sustainable, but that such interventions have not been systematically explored, tested or implementedThe objectives of this one year project (part of a extensive five-year programme) are: 1) describe existing situation in terms of policies, training, activities, and culture for clinical handover between primary and secondary care during referrals and discharge 2)identify barriers and facilitators (health care system and patient related) for improving clinical handover 3)develop options for intervention 4)build health systems research capacity. These will be achieved through a range of complex research methods that would involve all stakeholders from policy makers to patients.The immediate benefits of this phase will be for the hospital and community health care practitioners and policy makers who will be able to use the findings to start addressing some of the affordable solutions identified, researchers who will learn health system assessment techniques novel to them, and ultimately the patients who will receive a better seamless health care through the development and implementation of interventions. The follow-on intervention study is hoped to roll out into long-term programmes that could dramatically improve integration of primary and hospital care services.

有效整合社区(初级)和医院(二级)保健服务之间的护理对于需求超出最初发作的病人至关重要，而下一级卫生服务提供者需要更多的护理。这可能包括如果初级保健医生不能控制病情或在入院后继续在初级保健中服药和体检，则可转诊至医院。关键阶段是为了确保患者护理的连续性和安全性，将患者特定信息从一个护理者传递到另一个护理者或患者和家人，称为临床移交。对高收入国家证据的审查表明，无效移交的后果导致不正确的治疗、医疗诊断延误、危及生命的不良事件、病人投诉、保健支出增加、住院时间延长、重新入院以及对卫生系统的其他影响。尽管我们未能找到LMIC的类似数据，但经验以及与合作伙伴和专家的讨论表明，由于卫生保健提供者的整合存在巨大差距，LMIC因移交不力而发生不良事件和其他不良后果的比率甚至更高。因此，很可能存在相当大的余地，以符合成本效益的方式改进做法，甚至有可能降低成本。这些方法可借鉴已在高收入国家成功实施的方法(例如，检查表、患者持有的记录)。世卫组织将全球重点放在卫生系统发展上，这对于更好地应对紧急情况、传染病和其他疾病的挑战至关重要。老年人口的增加和低收入国家日益恶化的生活方式(如吸烟率)增加了与心脏有关的疾病、糖尿病和其他长期疾病的负担。由于他们需要持续护理，初级和二级护理之间的融合不佳对他们产生了特别不利的影响。因此，我们建议的主要驱动力是以下方面的证据：-临床移交过程是患者安全的核心，临床移交不充分会导致患者结局不佳和医疗系统成本高昂--临床移交是世卫组织患者安全计划确定的全球优先事项。许多低收入中等收入国家需要并有兴趣改善各级保健之间的融合，但几乎没有证据来指导地方决策者如何确定和克服改善做法的障碍--初步干预措施在文化和政治上是可以接受的、负担得起的和可持续的，但这种干预措施尚未得到系统地探索、测试或实施。这个一年项目(广泛的五年计划的一部分)的目标是：1)从政策、培训、活动、2)确定改善临床移交的障碍和促进者(卫生保健系统和患者相关)3)制定干预方案4)建设卫生系统研究能力。这些将通过一系列复杂的研究方法来实现，这些方法将涉及从政策制定者到患者的所有利益相关者。这一阶段的直接好处将是医院和社区卫生保健从业者和政策制定者将能够利用这些发现开始解决一些已确定的负担得起的解决方案，研究人员将学习对他们来说是新的卫生系统评估技术，最终将通过开发和实施干预措施获得更好的无缝卫生保健。后续干预研究有望推广到长期计划中，从而极大地改善初级和医院护理服务的整合。

项目成果

Exploring Factors Affecting Health Care Providers' Behaviors for Maintaining Continuity of Care in Kerala, India; A Qualitative Analysis Using the Theoretical Domains Framework.

• DOI: 10.3389/fpubh.2022.891103
• 发表时间: 2022
• 期刊: FRONTIERS IN PUBLIC HEALTH
• 影响因子: 5.2
• 作者: Joseph, Linju;Greenfield, Sheila;Lavis, Anna;Lekha, T. R.;Panniyammakal, Jeemon;Manaseki-Holland, Semira
• 通讯作者: Manaseki-Holland, Semira

Patients', carers' and healthcare providers' views of patient-held health records in Kerala, India: A qualitative exploratory study.

• DOI: 10.1111/hex.13721
• 发表时间: 2023-06
• 期刊: HEALTH EXPECTATIONS
• 影响因子: 3.2
• 作者: Joseph, Linju;Greenfield, Sheila;Manaseki-Holland, Semira;Lekha, T. R.;Sujakumari, S.;Panniyammakal, Jeemon;Lavis, Anna
• 通讯作者: Lavis, Anna

Systematic review on the use of patient-held health records in low-income and middle-income countries.

关于低收入和中等收入国家使用患者控制的健康记录的系统审查。

• DOI: 10.1136/bmjopen-2020-046965
• 发表时间: 2021-09-02
• 期刊: BMJ open
• 影响因子: 2.9
• 作者: Joseph L;Lavis A;Greenfield S;Boban D;Humphries C;Jose P;Jeemon P;Manaseki-Holland S
• 通讯作者: Manaseki-Holland S

Investigating discharge communication for chronic disease patients in three hospitals in India.

调查印度三家医院慢性病患者的出院沟通情况。

• DOI: 10.1371/journal.pone.0230438
• 发表时间: 2020
• 期刊: PloS one
• 影响因子: 3.7
• 作者: Humphries C

A systematic review of home-based records in maternal and child health for improving informational continuity, health outcomes, and perceived usefulness in low and middle-income countries.

• DOI: 10.1371/journal.pone.0267192
• 发表时间: 2022
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Joseph, Linju;Lavis, Anna;Greenfield, Sheila;Boban, Dona;Jose, Prinu;Jeemon, Panniyammakal;Manaseki-Holland, Semira
• 通讯作者: Manaseki-Holland, Semira