PDF(Pubmed)
Abstract：
BACKGROUND: Person-centred medicine is recommended in the care of older patients. Yet, involvement of care home residents and relatives in medication processes remains limited in routine care. Therefore, we aimed to develop a complex intervention focusing on resident and relative involvement and interprofessional communication to support person-centred medicine in the care home setting.
METHODS: The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach.
RESULTS: Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting.
CONCLUSIONS: Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study.
METHODS: The development took place from October 2021 to March 2022 in the Municipality of Aarhus, Denmark. The study followed the Medical Research Council guidance on complex intervention development using a combination of theoretical, evidence-based, and partnership approaches. The patient involvement tool, the PREparation of Patients for Active Involvement in medication Review (PREPAIR), was included in a preliminary intervention model. Study activities included developing programme theory, engaging stakeholders, and exploring key uncertainties through interviews, co-producing workshops, and testing with end-users to develop the intervention and an implementation strategy. The Consolidated Framework for Implementation Research and the Interprofessional Shared Decision Making Model were used. Data were analysed using a rapid analysis approach.
RESULTS: Before the workshops, six residents and four relatives were interviewed. Based on their feedback, PREPAIR was modified to the PREPAIR care home to fit the care home population. In total, ten persons participated in the co-producing workshops, including health care professionals and municipal managerial and quality improvement staff. The developed intervention prototype was tested for three residents and subsequently refined to the final intervention, including two fixed components (PREPAIR care home and an interprofessional medication communication template) delivered in a flexible three-stage workflow. Additionally, a multi-component implementation strategy was formed. In line with the developed programme theory, the intervention supported health care professionals´ awareness about resident and relative involvement. It provided a structure for involvement, empowered the residents to speak, and brought new insights through dialogue, thereby supporting involvement in medication-related decisions. The final intervention was perceived to be relevant, acceptable, and feasible in the care home setting.
CONCLUSIONS: Our results indicate that the final intervention may be a viable approach to facilitate person-centred medicine through resident and relative involvement. This will be further explored in a planned feasibility study.
摘要：
背景：在老年患者的护理中，推荐以人为中心的药物。然而，护理院居民和亲属参与药物治疗过程在常规护理中仍然有限.因此,我们旨在开发一种复杂的干预措施，重点是住院医师和相关人员的参与以及跨专业沟通，以支持在养老院环境中以人为中心的医学。
方法：开发于2021年10月至2022年3月在奥胡斯市进行，丹麦。该研究遵循医学研究委员会关于复杂干预发展的指导，以证据为基础,和伙伴关系方法。患者参与工具，积极参与药物审查的患者准备工作（PREPAIR），包括在初步干预模型中。研究活动包括开发计划理论，参与利益相关者，通过采访探索关键的不确定性，联合生产车间，并与最终用户进行测试，以制定干预措施和实施策略。使用了实施研究的综合框架和跨专业共享决策模型。使用快速分析方法分析数据。
结果：在研讨会之前，六名居民和四名亲属接受了采访。根据他们的反馈,PREPAIR被修改为PrePAIR养老院，以适应养老院人口。总的来说,十人参加了联合制作讲习班，包括卫生保健专业人员和市政管理和质量改进人员。开发的干预原型对三名居民进行了测试，随后进行了最终干预，包括两个固定组件（PREPAIR疗养院和一个跨专业的药物沟通模板）在一个灵活的三阶段的工作流程交付。此外,形成了一个多部分的实施战略。根据发达的计划理论，该干预措施支持卫生保健专业人员对居民和相关参与的认识.它提供了参与的结构，授权居民发言，通过对话带来了新的见解，从而支持参与药物相关决策。最后的干预被认为是相关的，可接受,在养老院环境中也是可行的。
结论：我们的结果表明，最终干预可能是通过居民和相关参与促进以人为本的医学的可行方法。这将在计划的可行性研究中进一步探讨。
方法：开发于2021年10月至2022年3月在奥胡斯市进行，丹麦。该研究遵循医学研究委员会关于复杂干预发展的指导，以证据为基础,和伙伴关系方法。患者参与工具，积极参与药物审查的患者准备工作（PREPAIR），包括在初步干预模型中。研究活动包括开发计划理论，参与利益相关者，通过采访探索关键的不确定性，联合生产车间，并与最终用户进行测试，以制定干预措施和实施策略。使用了实施研究的综合框架和跨专业共享决策模型。使用快速分析方法分析数据。
结果：在研讨会之前，六名居民和四名亲属接受了采访。根据他们的反馈,PREPAIR被修改为PrePAIR养老院，以适应养老院人口。总的来说,十人参加了联合制作讲习班，包括卫生保健专业人员和市政管理和质量改进人员。开发的干预原型对三名居民进行了测试，随后进行了最终干预，包括两个固定组件（PREPAIR疗养院和一个跨专业的药物沟通模板）在一个灵活的三阶段的工作流程交付。此外,形成了一个多部分的实施战略。根据发达的计划理论，该干预措施支持卫生保健专业人员对居民和相关参与的认识.它提供了参与的结构，授权居民发言，通过对话带来了新的见解，从而支持参与药物相关决策。最后的干预被认为是相关的，可接受,在养老院环境中也是可行的。
结论：我们的结果表明，最终干预可能是通过居民和相关参与促进以人为本的医学的可行方法。这将在计划的可行性研究中进一步探讨。
