■已经提出了一种基于息肉的实施策略,以提高射血分数降低的心力衰竭患者的指南指导药物治疗(GDMT)的发生率。这有可能改善印度的死亡率和发病率以及全球治疗不足的人群。
■我们进行了一项趋同的并行混合方法研究,该研究整合了来自利益相关者调查的定量数据,使用了改进的实施科学成果衡量标准和来自关键线人深度访谈的定性数据。我们的目标是探索医生,护士,药剂师,和患者对2021年1月至2021年4月印度HFrEF息肉实施战略的看法。整合了定量和定性数据,以开发实施研究逻辑模型。
■在利益相关者调查的69名受访者中,有中等可接受性(平均值[SD]3.8[1.0]),适当性(3.6[1.0]),HFrEF息肉实施策略的可行性(3.7[1.0])。关键线人深度访谈的参与者(n=20)强调了HFrEFpolypill创新的许多相对优势,包括简化药物治疗方案和提高患者依从性的潜力。阐明了关键的相对缺点,包括对副作用的担忧,以及由于息肉停药或住院治疗而导致的多种GDMT药物中断。根据这些数据,实施研究逻辑模型中提出的实施策略包括1)HFrEF息肉,2)HFrEF息肉起始,滴定,和维护协议,和3)我们假设的HFrEF息肉实验室安全性监测方案将通过多种机制,包括增加对单一药丸的药物依从性,从而导致预期的临床和实施结果。
■这项研究表明,基于HFrEF多丸的实施策略被认为是可以接受的,可行,在印度的医疗保健提供者中也是合适的。我们确定了上下文相关的决定因素,战略,机制,以及实施研究逻辑模型中概述的结果,以指导未来的研究以改善南亚的心力衰竭护理。
UNASSIGNED: A polypill-based implementation strategy has been proposed to increase rates of guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction. This has the potential to improve mortality and morbidity in India and undertreated populations globally.
UNASSIGNED: We conducted a convergent parallel mixed methods study integrating quantitative data from stakeholder surveys using modified implementation science outcome measures and qualitative data from key informant in-depth interviews. Our objective was to explore physician, nurse, pharmacist, and patient perspectives on a HFrEF polypill implementation strategy in India from January 2021 to April 2021. Quantitative and qualitative data were integrated to develop an Implementation Research Logic Model.
UNASSIGNED: Among 69 respondents to the stakeholder survey, there was moderate acceptability (mean [SD] 3.8 [1.0]), appropriateness (3.6 [1.0]), and feasibility (3.7 [1.0]) of HFrEF polypill implementation strategy. Participants in the key-informant in-depth interviews (n = 20) highlighted numerous relative advantages of the HFrEF polypill innovation including potential to simplify medication regimens and improve patient adherence. Key relative disadvantages elucidated, include concerns about side effects and interruption of multiple GDMT medications due to polypill discontinuation for side effects or hospitalizations. Based on this data, the proposed implementation strategies in the Implementation Research Logic Model include 1) HFrEF polypills, 2) HFrEF polypill initiation, titration, and maintenance protocols, and 3) HFrEF polypill laboratory monitoring protocols for safety which we postulate will lead to desired clinical and implementation outcomes through multiple mechanisms including increased medication adherence to a single pill.
UNASSIGNED: This study demonstrates that a HFrEF polypill-based implementation strategy is considered acceptable, feasible, and appropriate among healthcare providers in India. We identified contextually relevant determinants, strategies, mechanism, and outcomes outlined in an Implementation Research Logic Model to inform future research to improve heart failure care in South Asia.