■患有多种长期疾病的人代表了国家卫生服务政策和实践的重大关注,他们的护理是2019年国家卫生服务长期计划的主题。伯明翰兰德和剑桥快速评估中心团队对2018年至2023年进行的10项评估进行了专题综合,探索需求,对患有多种长期疾病的人的优先事项和影响。
■这项总体研究的目的是:(1)为具有多种长期条件的所有年龄段的人建立有关小学和社区环境中服务创新的学习体系,专注于对多病患者最重要的问题;(2)发展关于如何使用快速评估来告知范围的方法论见解,为具有多种长期条件的人测试和实施服务创新。
■对多个长期条件的关注来自伯明翰兰德和剑桥快速评估中心于2018年使用詹姆斯林德联盟方法进行的优先排序过程。对10项个人快速评估结果的交叉分析得到了补充:(1)将多发病率的各个方面纳入后期评估的设计;(2)采访在综合护理系统中或与之合作的国家和区域利益相关者(n=19);(3)对具有多种长期条件的人进行远程监测的证据进行快速审查(包括19篇论文);(4)通过患者代表患者和护理人员的组织测试整体见解,公共和专业参与研讨会,有10名参与者和研究小组成员。
■虽然长期生活在多种疾病中很常见,并且是50岁以上使用医疗保健服务的人群的常态,它通常不是卫生服务提供或创新的重点,也没有研究和评估活动。我们讨论了整个研究中出现的六个主题:(1)我们的卫生系统主要围绕单个条件而不是多个长期条件进行组织;(2)研究电话和研究通常集中在单个条件和相关服务上;(3)建立参与的机会,(4)对患者和护理人员重要的措施的重要性;(5)为患有多种长期疾病的人开发和实施服务创新的障碍;(6)使患有多种长期疾病的患者成为医疗保健计划和交付的优先事项所需的条件。
对患有多种长期疾病的人的护理并不是几项快速评估的主要重点。虽然这本身就是一个发现,它限制了我们对设计和实施的学习,以及评估的方法论方法,为具有多种长期条件的人提供服务创新。
■通过对评估组合的主题分析,我们已经推导出了一系列建议的含义,即如何将具有多种长期条件的人的需求更好地嵌入政策中,研究和实践。
■应进一步探索与具有多种长期状况的人的护理有关的不确定性领域,包括制定和测试跨环境(非)协调护理患者体验的措施,并询问与具有多种长期疾病的人一起工作时医疗保健人员的经验,了解什么是有效的。
■该奖项由国家健康与护理研究所(NIHR)健康与社会护理提供研究计划(NIHR奖参考:NIHR134284)资助,并在健康与社会护理提供研究中全文发表。12号15.有关更多奖项信息,请参阅NIHR资助和奖励网站。
在英格兰,许多人生活在两个或两个以上的身体和/或心理健康状况,预计将持续多年。估计各不相同,但它很可能是大多数国家卫生服务服务的人生活在两个或两个以上的长期条件。我们想知道当引入新的医疗保健类型时,这个群体的需求得到了多好的考虑,或重组现有服务。要做到这一点,我们回顾了伯明翰兰德和剑桥评估中心从2018年到2023年研究的所有10项卫生服务创新。我们做了一些额外的研究,包括与患者代表的讨论以及与国家和地区各级国家卫生服务政策制定者和管理人员的访谈。我们还研究了关于一项新医疗技术的一个例子的新研究,该技术旨在帮助患有多种长期健康状况的人:卫生服务人员可以使用的监测器来测量患者在自己家中的症状。我们的主要发现是,国家卫生服务部门的大多数注意力都集中在组织单一疾病的护理上,他们经常被孤立对待。医护人员通常不会同时考虑患者的许多治疗方法和需求,也不是研究人员。对一种情况的护理往往与对患者可能存在的其他健康问题的护理不协调。尽管医护人员原则上理解患有多种长期健康状况的人的状况,管理者和研究人员,在实践中,为满足他们的需求所做的相对较少。最后,我们提出了政策制定者,医护人员和研究人员可以改善他们如何帮助患有多种长期疾病的人。
UNASSIGNED: People living with multiple long-term conditions represent a significant concern for National Health Service policy and practice, and their care is a major theme in the 2019 National Health Service Long Term Plan. The Birmingham RAND and Cambridge Rapid Evaluation Centre team has undertaken a thematic synthesis of the 10 evaluations it has conducted from 2018 to 2023, exploring the needs, priorities and implications for people with multiple long-term conditions.
UNASSIGNED: The aims for this overarching study were to: (1) build a body of learning about service innovations in primary and community settings for people of all ages with multiple long-term conditions, focused on questions that matter most to people with multimorbidity; and (2) develop methodological insights about how rapid evaluation can be used to inform the scoping, testing and implementation of service innovations for people with multiple long-term conditions.
UNASSIGNED: The focus on multiple long-term conditions came from a Birmingham RAND and Cambridge Rapid Evaluation Centre prioritisation process undertaken in 2018 using James Lind Alliance methods. Cross-analysis of the findings from the 10 individual rapid evaluations was supplemented by (1) building aspects of multimorbidity into the design of later evaluations; (2) interviewing national and regional stakeholders (n=19) working in or alongside integrated care systems; (3) undertaking a rapid review of evidence on remote monitoring for people with multiple long-term conditions (19 papers included); and (4) testing overall insights with organisations representing patients and carers through a patient, public and professional engagement workshop with 10 participants plus members of the research team.
UNASSIGNED: While living with multiple long-term conditions is common and is the norm for people over the age of 50 using health and care services, it is not often a focus of health service provision or innovation, nor of research and evaluation activity. We discuss six themes emerging from the totality of the study: (1) our health system is mainly organised around single conditions and not multiple long-term conditions; (2) research calls and studies usually focus on single conditions and associated services; (3) building opportunities for engaged, informed individuals and carers and improved self-management; (4) the importance of measures that matter for patients and carers; (5) barriers to developing and implementing service innovations for people with multiple long-term conditions; and (6) what is needed to make patients with multiple long-term conditions a priority in healthcare planning and delivery.
UNASSIGNED: Care of people with multiple long-term conditions was not the principal focus of several of the rapid evaluations. While this was a finding in itself, it limited our learning about designing and implementing, as well as methodological approaches to evaluating, service innovations for people with multiple long-term conditions.
UNASSIGNED: Through a thematic analysis of the portfolio of evaluations, we have deduced a set of suggested implications for how the needs of people with multiple long-term conditions can be better embedded in policy, research and practice.
UNASSIGNED: Areas of uncertainty related to the care of people with multiple long-term conditions should be further explored, including developing and testing measures of patient experience of (un)co-ordinated care across settings, and interrogating the experience of health and care staff when working with people with multiple long-term conditions, to understand what works.
UNASSIGNED: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR134284) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information.
Many people in England live with two or more physical and/or mental health conditions that are expected to last for years. Estimates vary, but it is likely that a majority of National Health Service services are serving people living with two or more long-term conditions. We wanted to find out how well the needs of this group are taken into account when new types of health care are introduced, or existing services are reorganised. To do this, we went back to all 10 of the health service innovations that had been studied by our Birmingham RAND and Cambridge Evaluation Centre from 2018 to 2023. We did some extra research, including discussions with patient representatives and interviews with National Health Service policy-makers and managers at national and regional levels. We also looked at what new research had been published about one example of a new healthcare technology that is intended to help people who have several long-term health conditions: monitors that can be used by health service staff to measure patients’ symptoms when they are in their own home. Our main finding was that most National Health Service attention is given to organising care for single conditions, often treating them in isolation. Patients’ many treatments and needs are not routinely considered all at the same time by healthcare staff, nor by researchers. Care for one condition is too often not co-ordinated with care for other health problems that a patient may have. Although the situation of people living with several long-term health conditions is in principle understood by healthcare staff, managers and researchers, relatively little is done in practice to meet their needs. We conclude by suggesting ways that policy-makers, healthcare staff and researchers could improve how they help people living with multiple long-term conditions.