■已经呼吁护理人员拥有某种形式的护理途径,他们可以用来安全地将患有癫痫的成年人从急诊科转移出去,并促进门诊护理的改善。不同的配置是可能的。要知道实施/评估的优先顺序,有必要确定哪些是服务用户可以接受的,并且可能是国民健康服务可行的。
■(1)确定正在考虑的配置,(2)了解服务用户对他们的看法和当前的规定,(3)确定什么样的护理服务用户想要和(4)确定哪些配置(S)被认为是在满足用户的偏好和是国民健康服务可行的最佳平衡。
■对服务提供商进行了调查,以实现目标1。与服务用户的访谈涉及目标2。通过完成离散选择实验来解决目标3。这些确定了用户对不同癫痫发作情况的护理偏好。通过完成“知识交流”讲习班来解决目标4。在这些,利益相关者考虑了用户陈述偏好的调查结果,并根据Michie的可接受性判断了不同的途径配置,实用性,有效性,负担能力,副作用和公平可行性标准。
■这个项目发生在英国。该调查招募了神经病学和神经科学中心以及紧急和紧急护理提供者的代表。对于采访,招募是通过第三部门支持小组进行的。通过西北救护车服务NHS信托基金和公共广告进行了离散选择实验的招募。研讨会参与者从神经病学和神经科学中心招募,紧急和紧急护理提供者,支持小组和调试网络。
■72个服务部门完成了调查。对25名癫痫患者(和5名亲属)进行了采访,他们在过去12个月内曾与紧急服务联系。离散选择实验由427名患有癫痫的成年人(和167名亲属)完成,他们在过去12个月内与救护车服务联系。与27个利益攸关方完成了讲习班。
■调查确定了一系列途径配置。他们在将患者带到何处以及促进门诊护理改善的潜力方面有所不同。在设计它们时很少咨询用户。离散选择实验发现,用户想要的护理配置与所提供的配置明显不同。在整个癫痫发作情况下,用户希望他们的护理人员能够访问他们的医疗记录;对于癫痫专家(例如癫痫护士,神经科医生)可以提供建议;让他们的全科医生收到报告;事件与癫痫专家预约;护理事件持续<6小时;并且有一种偏好模式,以避免运送到急诊室并留在原地。利益相关者认为这种配置在5-10年内是国家卫生服务可行的,一些元素可以立即部署。
■离散选择实验样本具有广泛代表性,但是那些报告最近与癫痫专家接触的人代表过多。
■用户表示他们想要的护理配置与当前配置明显不同。他们喜欢的配置是,在支持和投资下,被认为可能是国家卫生服务可行的。现在应开发和评估首选配置,以确定其实际可输送性和有效性。
■该研究注册为researchregistry4723。
■该奖项由美国国家卫生与护理研究所(NIHR)卫生与社会护理提供研究计划(NIHR奖参考:17/05/62)资助,并在《健康与社会护理提供研究》中全文发表。12号24.有关更多奖项信息,请参阅NIHR资助和奖励网站。
救护车经常照顾癫痫患者。他们中的大多数被送往医院的事故和急诊科。这通常几乎没有益处,因为大多数患者已经被诊断并且在非紧急状态下访问事故和急诊科。为了改变事物,国家卫生服务组织希望护理人员使用“替代护理途径”。这可能意味着该人不会被带到事故和急诊室,而是在其他地方得到照顾。我们的项目将利益相关者聚集在一起,以开发替代护理途径,其中包括对患者和护理人员重要的事情,但也是国家卫生服务可行的。70个国家卫生服务组织首先通过调查和研讨会告诉我们,他们正在考虑哪些途径以及哪些途径可能可行。然后采访了30名癫痫患者及其家人和朋友。他们解释了癫痫发作后的需求以及当前护理的问题。一个问题是,去事故和急诊科不会导致他们与癫痫专家进行后续预约,以检查他们的治疗是否正确。使用“离散选择实验”,大约430名癫痫患者最近联系了救护车服务,他们的170名家人和朋友被要求在替代护理方案之间做出选择,说出他们在不同的癫痫发作情况下更喜欢哪种途径。结果很清楚。人们想要的护理与国家卫生服务组织告诉我们的不同。选择实验表明,每个人都更喜欢护理人员可以访问其医疗记录的途径,癫痫专家可以为护理人员提供建议,全科医生会收到一份报告,他们将来会预约癫痫专家。每个人都希望避免长时间的护理(6小时),并且在典型的癫痫发作后,癫痫患者希望呆在家里。有三个车间和护理人员一起开,癫痫专家和经理。他们说,用户想要的替代护理途径可能是国家卫生服务机构可行的。现在有必要实施和评估它。
UNASSIGNED: Calls have been made for paramedics to have some form of care pathway that they could use to safely divert adults with epilepsy away from emergency departments and instigate ambulatory care improvements. Different configurations are possible. To know which to prioritise for implementation/evaluation, there is a need to determine which are acceptable to service users and likely National Health Service-feasible.
UNASSIGNED: (1) Identify configurations being considered, (2) understand service users\' views of them and current provision, (3) identify what sort of care service users want and (4) determine which configuration(s) is considered to achieve optimal balance in meeting users\' preference and being National Health Service-feasible.
UNASSIGNED: Service providers were surveyed to address objective 1. Interviews with service users addressed objective 2. Objective 3 was addressed by completing discrete choice experiments. These determined users\' care preferences for different seizure scenarios. Objective 4 was addressed by completing \'knowledge exchange\' workshops. At these, stakeholders considered the findings on users\' stated preferences and judged different pathway configurations against Michie\'s \'acceptability, practicability, effectiveness, affordability, side-effects and equity\' feasibility criteria.
UNASSIGNED: This project took place in England. The survey recruited representatives from neurology and neuroscience centres and from urgent and emergency care providers. For the interviews, recruitment occurred via third-sector support groups. Recruitment for discrete choice experiments occurred via the North West Ambulance Service NHS Trust and public advert. Workshop participants were recruited from neurology and neuroscience centres, urgent and emergency care providers, support groups and commissioning networks.
UNASSIGNED: Seventy-two services completed the survey. Interviews were conducted with 25 adults with epilepsy (and 5 relatives) who had emergency service contact in the prior 12 months. Discrete choice experiments were completed by 427 adults with epilepsy (and 167 relatives) who had ambulance service contact in the prior 12 months. Workshops were completed with 27 stakeholders.
UNASSIGNED: The survey identified a range of pathway configurations. They differed in where they would take the patient and their potential to instigate ambulatory care improvements. Users had been rarely consulted in designing them. The discrete choice experiments found that users want a configuration of care markedly different to that offered. Across the seizure scenarios, users wanted their paramedic to have access to their medical records; for an epilepsy specialist (e.g. an epilepsy nurse, neurologist) to be available to advise; for their general practitioner to receive a report; for the incident to generate an appointment with an epilepsy specialist; for the care episode to last < 6 hours; and there was a pattern of preference to avoid conveyance to emergency departments and stay where they were. Stakeholders judged this configuration to be National Health Service-feasible within 5-10 years, with some elements being immediately deployable.
UNASSIGNED: The discrete choice experiment sample was broadly representative, but those reporting recent contact with an epilepsy specialist were over-represented.
UNASSIGNED: Users state they want a configuration of care that is markedly different to current provision. The configuration they prefer was, with support and investment, judged to likely be National Health Service-feasible. The preferred configuration should now be developed and evaluated to determine its actual deliverability and efficacy.
UNASSIGNED: The study is registered as researchregistry4723.
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: 17/05/62) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 24. See the NIHR Funding and Awards website for further award information.
Ambulances often attend to people with epilepsy. Most of them are taken to the hospital’s accident and emergency department. This typically has little benefit since most patients are already diagnosed and visit the accident and emergency department with non-emergency states. To change things, National Health Service organisations want an ‘alternative care pathway’ for paramedics to use. It could mean the person is not taken to the accident and emergency department but cared for elsewhere. Our project brought stakeholders together to develop an alternative care pathway that includes things important to patients and carers but is also National Health Service-feasible. Seventy National Health Service organisations first told us via a survey and a workshop which pathways they were considering and which might be feasible. Thirty people with epilepsy and their family members and friends were then interviewed. They explained what is wanted after a seizure and problems with current care. One problem was that going to the accident and emergency department does not lead to them getting a follow-up appointment with an epilepsy specialist to check their treatment is right. Using ‘discrete choice experiments’, around 430 people with epilepsy who recently contacted the ambulance service and 170 of their family and friends were asked to make a choice between alternative packages of care, to say which pathway they would prefer in different seizure situations. The results were clear. People wanted care different from what National Health Service organisations told us was available. The choice experiment showed everyone prefers pathways where paramedics have access to their medical records, an epilepsy specialist is available to advise the paramedic, the general practitioner gets a report and they get an appointment with an epilepsy specialist in the future. Everyone wants to avoid long episodes of care (6 hours) and after a typical seizure people with epilepsy want to stay at home. Three workshops were run with paramedics, epilepsy specialists and managers. They said the alternative care pathway wanted by users could be National Health Service-feasible. There is a need to implement and evaluate it now.