PDF(Pubmed)
Abstract：
BACKGROUND: Alcohol-related mortality and morbidity increased during the COVID-19 pandemic in England, with people from lower-socioeconomic groups disproportionately affected. The North East and North Cumbria (NENC) region has high levels of deprivation and the highest rates of alcohol-related harm in England. Consequently, there is an urgent need for the implementation of evidence-based preventative approaches such as identifying people at risk of alcohol harm and providing them with appropriate support. Non-alcohol specialist secondary care clinicians could play a key role in delivering these interventions, but current implementation remains limited. In this study we aimed to explore current practices and challenges around identifying, supporting, and signposting patients with Alcohol Use Disorder (AUD) in secondary care hospitals in the NENC through the accounts of staff in the post COVID-19 context.
METHODS: Semi-structured qualitative interviews were conducted with 30 non-alcohol specialist staff (10 doctors, 20 nurses) in eight secondary care hospitals across the NENC between June and October 2021. Data were analysed inductively and deductively to identify key codes and themes, with Normalisation Process Theory (NPT) then used to structure the findings.
RESULTS: Findings were grouped using the NPT domains \'implementation contexts\' and \'implementation mechanisms\'. The following implementation contexts were identified as key factors limiting the implementation of alcohol prevention work: poverty which has been exacerbated by COVID-19 and the prioritisation of acute presentations (negotiating capacity); structural stigma (strategic intentions); and relational stigma (reframing organisational logics). Implementation mechanisms identified as barriers were: workforce knowledge and skills (cognitive participation); the perception that other departments and roles were better placed to deliver this preventative work than their own (collective action); and the perceived futility and negative feedback cycle (reflexive monitoring).
CONCLUSIONS: COVID-19, has generated additional challenges to identifying, supporting, and signposting patients with AUD in secondary care hospitals in the NENC. Our interpretation suggests that implementation contexts, in particular structural stigma and growing economic disparity, are the greatest barriers to implementation of evidence-based care in this area. Thus, while some implementation mechanisms can be addressed at a local policy and practice level via improved training and support, system-wide action is needed to enable sustained delivery of preventative alcohol work in these settings.
METHODS: Semi-structured qualitative interviews were conducted with 30 non-alcohol specialist staff (10 doctors, 20 nurses) in eight secondary care hospitals across the NENC between June and October 2021. Data were analysed inductively and deductively to identify key codes and themes, with Normalisation Process Theory (NPT) then used to structure the findings.
RESULTS: Findings were grouped using the NPT domains \'implementation contexts\' and \'implementation mechanisms\'. The following implementation contexts were identified as key factors limiting the implementation of alcohol prevention work: poverty which has been exacerbated by COVID-19 and the prioritisation of acute presentations (negotiating capacity); structural stigma (strategic intentions); and relational stigma (reframing organisational logics). Implementation mechanisms identified as barriers were: workforce knowledge and skills (cognitive participation); the perception that other departments and roles were better placed to deliver this preventative work than their own (collective action); and the perceived futility and negative feedback cycle (reflexive monitoring).
CONCLUSIONS: COVID-19, has generated additional challenges to identifying, supporting, and signposting patients with AUD in secondary care hospitals in the NENC. Our interpretation suggests that implementation contexts, in particular structural stigma and growing economic disparity, are the greatest barriers to implementation of evidence-based care in this area. Thus, while some implementation mechanisms can be addressed at a local policy and practice level via improved training and support, system-wide action is needed to enable sustained delivery of preventative alcohol work in these settings.
摘要：
背景：在英国COVID-19大流行期间，酒精相关的死亡率和发病率增加，来自较低社会经济群体的人受到不成比例的影响。东北和北坎布里亚郡（NENC）地区的贫困程度很高，与酒精有关的伤害率最高。因此,迫切需要实施基于证据的预防方法，例如识别有酒精伤害风险的人并为他们提供适当的支持。非酒精专科二级保健临床医生可以在提供这些干预措施方面发挥关键作用，但目前的实施仍然有限。在这项研究中，我们旨在探索当前的实践和挑战，支持,并通过COVID-19后背景下的工作人员账户，在NENC的二级保健医院为酒精使用障碍(AUD)患者提供路标。
方法：对30名非酒精专家（10名医生，20名护士）在2021年6月至10月期间在NENC的8家二级保健医院。对数据进行归纳和演绎分析，以确定关键代码和主题，然后用归一化过程理论(NPT)来构建研究结果。
结果：使用NPT域\'实现上下文\'和\'实现机制\'对调查结果进行分组。以下实施环境被确定为限制酒精预防工作实施的关键因素：COVID-19加剧了贫困，并优先考虑急性陈述（谈判能力）；结构污名（战略意图）；和关系污名（重新定义组织逻辑）。被确定为障碍的执行机制是:劳动力知识和技能(认知参与)；认为其他部门和角色比他们自己的部门和角色更有能力开展这项预防性工作(集体行动)；以及感知的徒劳和负面反馈周期(反身监测)。
结论：COVID-19对识别，支持,并在NENC的二级保健医院为AUD患者进行路标。我们的解释表明，实施环境，特别是结构性耻辱和日益扩大的经济差距，是这一领域实施循证护理的最大障碍。因此，虽然可以通过改进培训和支持在地方政策和实践层面解决一些实施机制，需要采取全系统的行动，以便在这些环境中持续提供预防性酒精工作。
方法：对30名非酒精专家（10名医生，20名护士）在2021年6月至10月期间在NENC的8家二级保健医院。对数据进行归纳和演绎分析，以确定关键代码和主题，然后用归一化过程理论(NPT)来构建研究结果。
结果：使用NPT域\'实现上下文\'和\'实现机制\'对调查结果进行分组。以下实施环境被确定为限制酒精预防工作实施的关键因素：COVID-19加剧了贫困，并优先考虑急性陈述（谈判能力）；结构污名（战略意图）；和关系污名（重新定义组织逻辑）。被确定为障碍的执行机制是:劳动力知识和技能(认知参与)；认为其他部门和角色比他们自己的部门和角色更有能力开展这项预防性工作(集体行动)；以及感知的徒劳和负面反馈周期(反身监测)。
结论：COVID-19对识别，支持,并在NENC的二级保健医院为AUD患者进行路标。我们的解释表明，实施环境，特别是结构性耻辱和日益扩大的经济差距，是这一领域实施循证护理的最大障碍。因此，虽然可以通过改进培训和支持在地方政策和实践层面解决一些实施机制，需要采取全系统的行动，以便在这些环境中持续提供预防性酒精工作。
