PDF(Pubmed)
Abstract：
OBJECTIVE: The aim of this integrative review is to determine the effectiveness of integrated heart failure (HF) care in terms of patient-, service- and resource-related outcomes, and to determine what model or characteristics of integrated care work best, for whom and in what contexts.
BACKGROUND: Integration of health and social care services is a significant driver in the development of better and more cost-effective health and social care systems in Europe and developed countries. As high users of health and social care services, considerable attention has been paid to the care of people with long-term conditions. HF is a progressive, prevalent and disabling condition, requiring complex management involving multiple health and social care agencies.
METHODS: An integrative review was conducted according to a framework by Whittemore and Knafl (2005). A literature search was undertaken using the databases: Medline, CINAHL, Embase, PsychINFO and the Cochrane Library, using key words of \'heart failure\' OR \'cardiac failure\' AND \'integrated\' OR \'multidisciplinary\' OR \'interdisciplinary\' OR \'multiprofessional\' OR \'interprofessional\' OR \'collaborative care\'. Application of the inclusion and exclusion criteria resulted in 17 articles being included in the review. Articles were screened and coded for methodological quality according to a two-point criteria. Data were extracted using a template and analysed thematically.
RESULTS: Integrated HF care results in enhanced quality of life (QoL), and improved symptom control and self-management. Reduced admission rates, reduced length of hospital stay, improved prescribing practices and better care co-ordination are also reported. There is more limited evidence for improved efficiency although overall costs may be reduced. Although findings are highly context dependent, key features of integrated HF models are: liaison between primary and secondary care services to facilitate planned discharge, early and medium term follow-up, multidisciplinary patient education and team working including shared professional education, and the development and implementation of comprehensive care pathways.
BACKGROUND: Integration of health and social care services is a significant driver in the development of better and more cost-effective health and social care systems in Europe and developed countries. As high users of health and social care services, considerable attention has been paid to the care of people with long-term conditions. HF is a progressive, prevalent and disabling condition, requiring complex management involving multiple health and social care agencies.
METHODS: An integrative review was conducted according to a framework by Whittemore and Knafl (2005). A literature search was undertaken using the databases: Medline, CINAHL, Embase, PsychINFO and the Cochrane Library, using key words of \'heart failure\' OR \'cardiac failure\' AND \'integrated\' OR \'multidisciplinary\' OR \'interdisciplinary\' OR \'multiprofessional\' OR \'interprofessional\' OR \'collaborative care\'. Application of the inclusion and exclusion criteria resulted in 17 articles being included in the review. Articles were screened and coded for methodological quality according to a two-point criteria. Data were extracted using a template and analysed thematically.
RESULTS: Integrated HF care results in enhanced quality of life (QoL), and improved symptom control and self-management. Reduced admission rates, reduced length of hospital stay, improved prescribing practices and better care co-ordination are also reported. There is more limited evidence for improved efficiency although overall costs may be reduced. Although findings are highly context dependent, key features of integrated HF models are: liaison between primary and secondary care services to facilitate planned discharge, early and medium term follow-up, multidisciplinary patient education and team working including shared professional education, and the development and implementation of comprehensive care pathways.
摘要：
目的：本综合评价的目的是确定综合心力衰竭（HF）护理在患者方面的有效性-与服务和资源相关的成果，并确定综合护理工作的最佳模式或特征，为谁以及在什么情况下。
背景：卫生和社会护理服务的整合是欧洲和发达国家发展更好，更具成本效益的卫生和社会护理系统的重要驱动力。作为健康和社会护理服务的高用户，对有长期病情的人的照顾已经给予了相当大的重视。HF是一个渐进的，普遍和致残的状况，需要涉及多个健康和社会护理机构的复杂管理。
方法：根据Whittemore和Knafl（2005）的框架进行了综合审查。使用以下数据库进行文献检索：Medline，CINAHL,Embase,PsychINFO和Cochrane图书馆，使用关键词\'心力衰竭\'或\'心力衰竭\'和\'综合\'或\'多学科\'或\'跨学科\'或\'多专业\'或\'跨专业\'或\'协作护理\'。纳入和排除标准的应用导致17篇文章被纳入审查。根据两点标准对文章进行筛选和方法学质量编码。使用模板提取数据并进行主题分析。
结果：综合HF护理可提高生活质量（QoL），改善症状控制和自我管理。录取率降低，缩短住院时间,还报告了改进的处方实践和更好的护理协调。尽管总体成本可能会降低，但提高效率的证据更为有限。尽管研究结果高度依赖于上下文，综合高频模式的主要特点是:初级和二级保健服务之间的联系，以促进计划出院，早期和中期随访，多学科患者教育和团队合作，包括共享专业教育，以及全面护理途径的开发和实施。
背景：卫生和社会护理服务的整合是欧洲和发达国家发展更好，更具成本效益的卫生和社会护理系统的重要驱动力。作为健康和社会护理服务的高用户，对有长期病情的人的照顾已经给予了相当大的重视。HF是一个渐进的，普遍和致残的状况，需要涉及多个健康和社会护理机构的复杂管理。
方法：根据Whittemore和Knafl（2005）的框架进行了综合审查。使用以下数据库进行文献检索：Medline，CINAHL,Embase,PsychINFO和Cochrane图书馆，使用关键词\'心力衰竭\'或\'心力衰竭\'和\'综合\'或\'多学科\'或\'跨学科\'或\'多专业\'或\'跨专业\'或\'协作护理\'。纳入和排除标准的应用导致17篇文章被纳入审查。根据两点标准对文章进行筛选和方法学质量编码。使用模板提取数据并进行主题分析。
结果：综合HF护理可提高生活质量（QoL），改善症状控制和自我管理。录取率降低，缩短住院时间,还报告了改进的处方实践和更好的护理协调。尽管总体成本可能会降低，但提高效率的证据更为有限。尽管研究结果高度依赖于上下文，综合高频模式的主要特点是:初级和二级保健服务之间的联系，以促进计划出院，早期和中期随访，多学科患者教育和团队合作，包括共享专业教育，以及全面护理途径的开发和实施。
