目标:定义共识建议,以改善医院药房之间的护理协调,血液学与护理,中心间和中心内,在血友病患者的护理中。
方法:由具有该领域经验的多学科专业人员小组确定并评估了改善血友病患者管理中护理协调的建议(医院药房,血液学和护理)并得到科学证据的支持。确定的建议是由兰德/加州大学洛杉矶分校共识方法(德尔菲调整)基于其适当性和评估,随后,他们的必要性。在这两种情况下,它使用了有序的李克特量表。通过不同的指标对数据进行统计分析。
结果:关于改善医院药房之间护理协调的53条建议,血液学和护理管理中的血友病患者被确定,分为八个作用区域:i)血友病单位,参考中心和多学科护理;ii)血液学的作用,血友病患者旅程中的医院药学和护理;iii)远程药房和远程医疗;iv)药代动力学监测;v)过渡到成人患者方案;vi)患者健康教育;vii)手术,急诊室和住院;和viii)结果评估。外部专家小组对所有建议进行了适当和必要的评估。
结论:血友病患者的旅程是复杂的,取决于不同的变量。它还需要不同的医疗保健专业人员的参与,他们必须在患者生命的所有阶段以协调和综合的方式行动,适应他们的个人需求。在这件事上,确定和商定的建议可以提高护理的连续性和质量,因为它们促进了参与这种病理学管理的专业人员的整合和协调,尤其是医院药房,血液学与护理。
Define consensus recommendations to improve care coordination between Hospital Pharmacy, Hematology and Nursing, inter- and intra-center, in the care of hemophilia patients.
Recommendations for the improvement of care coordination in the management of hemophilia patients were identified and assessed by a multidisciplinary panel of professionals with experience in this field (Hospital Pharmacy, Hematology and Nursing) and supported by scientific evidence. The identified recommendations were assessed by Rand/UCLA consensus methodology (Delphi-adapted) based on their appropriateness and, subsequently, on their necessity. In both cases, it was used ordinal Likert scale. Data were statistically analyzed through different metrics.
Fifty-three recommendations for the improvement of care coordination between Hospital Pharmacy, Hematology and Nursing in the management of hemophilia patients were identified, grouped into eight areas of action: i) Hemophilia units, reference centers and multidisciplinary care; ii) Role of Hematology, Hospital Pharmacy and Nursing in the patient journey of hemophilia patients; iii) Telepharmacy and telemedicine; iv) Pharmacokinetic monitoring; v) Transition to adult patient regimen; vi) Patient health education; vii) Surgery, emergency room and hospital admission; and viii) Outcome evaluation. All recommendations were assessed as appropriate and necessary by the external expert panel.
Hemophilia patient journey is complex and depends on different variables. It also requires the involvement of different healthcare professionals who must act in a coordinated and integrated manner at all stages of the patient\'s life, adapted to their individual needs. On this matter, the identified and agreed recommendations may improve continuity and quality of care, as they facilitate the integration and coordination of the professionals involved in the management of this pathology, especially Hospital Pharmacy, Hematology and Nursing.