PDF(Pubmed)
Abstract：
UNASSIGNED: Surveillance, screening, and evaluation for neurodevelopmental delays is a pivotal component of post-surgical care for children with congenital heart disease (CHD). However, challenges exist in implementing such neurodevelopmental follow-up care in international practice. This study aimed to characterise key barriers, enablers, and opportunities for implementing and delivering outpatient cardiac neurodevelopmental follow-up care in Australia.
UNASSIGNED: an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis.
UNASSIGNED: fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data.
UNASSIGNED: Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
UNASSIGNED: an exploratory descriptive qualitative study was conducted with healthcare professionals across Australia who had lived experience of designing, implementing, or delivering neurodevelopmental care for children with CHD. Online semi-structured interviews were conducted using a guide informed by the Consolidated Framework for Implementation Research to explore contextual influences. Interview transcripts were analysed using a rapid qualitative approach including templated summaries and hybrid deductive-inductive matrix analysis.
UNASSIGNED: fifty-two participants were interviewed. Perceived barriers and enablers were organised into six higher-order themes: factors in the broader environmental, economic, and political context; healthcare system factors; organisational-level factors; provider factors; patient and family factors; and care model factors. The largest number of barriers occurred at the healthcare system level (service accessibility, fragmentation, funding, workforce), while service providers demonstrated the most enabling factors (interprofessional relationships, skilled teams, personal characteristics). Strategies to improve practice included building partnerships; generating evidence; increasing funding; adapting for family-centred care; and integrating systems and data.
UNASSIGNED: Australia shares many similar barriers and enablers to cardiac neurodevelopmental care with other international contexts. However, due to unique geographical and health-system factors, care models and implementation strategies will require adaption to the local context to improve service provision.
摘要：
■监视，筛选,神经发育迟缓的评估是先天性心脏病(CHD)患儿术后护理的重要组成部分.然而,在国际惯例中，实施这种神经发育后续护理存在挑战。这项研究旨在表征关键障碍，启用者，以及在澳大利亚实施和提供门诊心脏神经发育随访护理的机会。
■对澳大利亚各地有设计经验的医疗保健专业人员进行了一项探索性描述性定性研究，实施，或为冠心病儿童提供神经发育护理。在线半结构化访谈是使用由实施研究综合框架提供的指南进行的，以探索上下文影响。使用快速定性方法分析访谈笔录，包括模板摘要和混合演绎-归纳矩阵分析。
■52名参与者接受了采访。感知到的障碍和促成因素被组织成六个高阶主题：更广泛的环境因素，经济,和政治背景；医疗保健系统因素；组织层面因素；提供者因素；患者和家庭因素；和护理模式因素。最大数量的障碍发生在医疗保健系统级别(服务可获得性，碎片化,资金,劳动力)，虽然服务提供商展示了最有利的因素(跨专业关系，熟练的团队,个人特征)。改进做法的战略包括建立伙伴关系；产生证据；增加资金；适应以家庭为中心的护理；以及整合系统和数据。
澳大利亚在心脏神经发育护理方面与其他国际环境有许多类似的障碍和促成因素。然而,由于独特的地理和卫生系统因素，护理模式和实施策略将需要适应当地情况，以改善服务提供。
■对澳大利亚各地有设计经验的医疗保健专业人员进行了一项探索性描述性定性研究，实施，或为冠心病儿童提供神经发育护理。在线半结构化访谈是使用由实施研究综合框架提供的指南进行的，以探索上下文影响。使用快速定性方法分析访谈笔录，包括模板摘要和混合演绎-归纳矩阵分析。
■52名参与者接受了采访。感知到的障碍和促成因素被组织成六个高阶主题：更广泛的环境因素，经济,和政治背景；医疗保健系统因素；组织层面因素；提供者因素；患者和家庭因素；和护理模式因素。最大数量的障碍发生在医疗保健系统级别(服务可获得性，碎片化,资金,劳动力)，虽然服务提供商展示了最有利的因素(跨专业关系，熟练的团队,个人特征)。改进做法的战略包括建立伙伴关系；产生证据；增加资金；适应以家庭为中心的护理；以及整合系统和数据。
澳大利亚在心脏神经发育护理方面与其他国际环境有许多类似的障碍和促成因素。然而,由于独特的地理和卫生系统因素，护理模式和实施策略将需要适应当地情况，以改善服务提供。
