关键词: Community setting Comprehensive geriatric assessment Meta-ethnography Older adults Out-patient Primary care Qualitative evidence synthesis

Mesh : Humans Aged Outpatients Geriatric Assessment / methods Caregivers / psychology Health Personnel Patient Satisfaction

来  源:   DOI:10.1186/s12875-023-02222-2   PDF(Pubmed)

Abstract:
Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary process that addresses an older adult\'s biopsychosocial capabilities to create an integrated and co-ordinated plan of care. While quantitative evidence that demonstrates the positive impacts of CGA on clinical and process outcomes has been synthesised, to date qualitative research reporting how older adults and service providers experience CGA has not been synthesised. This study aimed to systematically review and synthesise qualitative studies reporting community-dwelling older adults\', caregivers\' and healthcare professionals\' (HCP) experiences of CGA in the primary care and out-patient (OPD) setting.
We systematically searched five electronic databases including MEDLINE, CINAHL, PsycINFO, PsycARTICLES and Social Sciences Full Text targeting qualitative or mixed methods studies that reported qualitative findings on older adults\', caregivers\' and HCPs\' experiences of CGA in primary care or out-patient settings. There were no language or date restrictions applied to the search. The protocol was registered with the PROSPERO database (Registration: CRD42021283167). The methodological quality of the included studies was appraised using the Critical Appraisal Skills Programme checklist for qualitative research. Results were synthesised according to Noblit and Hare\'s seven-step approach to meta-ethnography, which involves an iterative and inductive process of data synthesis.
Fourteen studies were included where CGA was completed in the home, general practice, out-patient setting in acute hospitals and in hybrid models across the community and hospital-based OPD settings. Synthesis generated four key themes: (1) CGA is experienced as a holistic process, (2) The home environment enhances CGA, (3) CGA in the community is enabled by a collaborative approach to care, and (4) Divergent experiences of the meaningful involvement of older adults, caregivers and family in the CGA process.
Findings demonstrate that CGA in a home-based or OPD setting allows for a holistic and integrated approach to care for community-dwelling older adults while increasing patient satisfaction and accessibility of healthcare. Healthcare professionals in the community should ensure meaningful involvement of older adults and their families or caregivers in the CGA process. Further robustly designed and well reported trials of different models of community-based CGA informed by the findings of this synthesis are warranted.
摘要:
背景:老年综合评估(CGA)是一个多维度的跨学科过程,旨在解决老年人的生物心理社会能力,以创建综合和协调的护理计划。虽然已经合成了证明CGA对临床和过程结果有积极影响的定量证据,迄今为止,尚未综合报道老年人和服务提供者如何体验CGA的定性研究。本研究旨在系统地回顾和综合报告社区居住老年人的定性研究,护理人员和医疗保健专业人员(HCP)在初级保健和门诊(OPD)设置中的CGA经验。
方法:我们系统地检索了五个电子数据库,包括MEDLINE,CINAHL,PsycINFO,精神病学和社会科学全文针对定性或混合方法研究,报告了老年人的定性发现,护理人员和HCP在初级保健或门诊患者中的CGA体验。没有语言或日期限制应用于搜索。该方案在PROSPERO数据库中注册(注册:CRD42021283167)。使用定性研究的关键评估技能计划清单评估了纳入研究的方法学质量。结果是根据Nablet和Hare的七步方法合成的,这涉及到数据合成的迭代和归纳过程。
结果:纳入了14项研究,其中CGA是在家中完成的,一般实践,急症医院的门诊设置以及社区和医院OPD设置的混合模式。综合产生了四个关键主题:(1)CGA是一个整体过程,(2)家居环境增强了CGA,(3)社区中的CGA是通过协作式护理方法实现的,和(4)老年人有意义的参与的不同经验,CGA过程中的护理人员和家人。
结论:研究结果表明,在家庭或OPD环境中,CGA可以采用整体和综合的方法来照顾社区居住的老年人,同时提高患者满意度和医疗保健的可及性。社区的医疗保健专业人员应确保老年人及其家人或护理人员有意义地参与CGA过程。根据该合成的发现,有必要对基于社区的CGA的不同模型进行进一步设计和报道良好的试验。
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