■本综述研究了以医疗保健团队为重点的干预措施,以管理长期居住或住院医疗机构中老年人的持续性或复发性痛苦行为。
■我们使用OvidMEDLINE搜索了针对医护人员(HCW)与遇险行为管理相关的知识和技能的干预措施,ElsevierEmbase,和OvidPsycINFO从2002年12月到2022年12月。
■我们筛选了6,582篇文章;29项随机试验符合纳入标准。关于患者面临的HCW相互作用的三项研究(例如,药物管理,诊断困扰)在躁动方面的结果好坏参半;一项研究发现对生活质量没有影响。六项以HCW为重点的研究表明,痛苦行为的短期减少。没有证据表明生活质量改善或减少抗精神病药的使用。在结合HCW重点活动和面向患者活动的17项干预措施中,0显示显著的窘迫减少,8例显示抗精神病药物显著减少(OR=0.79,95CI[0.69,0.91]),9例显示生活质量改善(SMD=0.71,95CI[0.39,1.04])。一项评估HCW的研究,患者-,以环境为重点的干预活动在躁动方面表现出短期改善。
■结合HCW培训和患者管理的新型医疗保健模式提高了患者的生活质量,减少抗精神病药的使用,并可能减少苦恼行为。需要评估干预措施对员工倦怠和利用率的影响。
UNASSIGNED: This review examines health care team-focused interventions on managing persistent or recurrent distress behaviors among older adults in long-term residential or inpatient health care settings.
UNASSIGNED: We searched interventions addressing health care worker (HCW) knowledge and skills related to distress behavior management using Ovid MEDLINE, Elsevier Embase, and Ovid PsycINFO from December 2002 through December 2022.
UNASSIGNED: We screened 6,582 articles; 29 randomized trials met inclusion criteria. Three studies on patient-facing HCW interactions (e.g. medication management, diagnosing distress) showed mixed results on agitation; one study found no effect on quality of life. Six HCW-focused studies suggested short-term reduction in distress behaviors. Quality-of-life improvement or decreased antipsychotic use was not evidenced. Among 17 interventions combining HCW-focused and patient-facing activities, 0 showed significant distress reduction, 8 showed significant antipsychotic reduction (OR = 0.79, 95%CI [0.69, 0.91]) and 9 showed quality of life improvements (SMD = 0.71, 95%CI [0.39, 1.04]). One study evaluating HCW, patient-, and environmental-focused intervention activities showed short-term improvement in agitation.
UNASSIGNED: Novel health care models combining HCW training and patient management improve patient quality of life, reduce antipsychotic use, and may reduce distress behaviors. Evaluation of intervention\'s effects on staff burnout and utilization is needed.