مقاله انگلیسی رایگان در مورد چه زمانی حسابرسی و بازخورد در مراقبت دمانس موثر است؟ – الزویر ۲۰۱۸

Background: Evidence-based care for people with dementia is a priority for patients, carers and clinicians and a policy priority. There is evidence that people with dementia do not always receive such care. Audit and feedback, also known as clinical audit, is an extensively-used intervention to improve care. However, there is uncertainty about the best way to use it. Objectives: To investigate whether audit and feedback is effective for improving health professionals’ care of people with dementia. To investigate whether the content and delivery of audit and feedback affects its effectiveness in the context of health professionals’ care for people with dementia. Design: Systematic review Data sources: The Cochrane Central Register of Controlled Trials, Prospero, Medline (1946–December week 1 2016), PsycInfo (1967–January 2017), Cinahl (1982–January 2017), HMIC (1979–January 2017), Embase (1974–۲۰۱۷ week 1) databases and the Science Citation Index and Social Science Citation Index were searched combining terms for audit and feedback, health personnel, and dementia. Review methods: Following screening, the data were extracted using the Template for Intervention Description and Replication (TIDieR), and synthesised graphically using harvest plots and narratively. Results: Thirteen studies met the inclusion criteria. Published studies of audit and feedback in dementia rarely described more than one cycle. None of the included studies had a comparison group: 12 were before and after designs and one was an interrupted time series without a comparison group. The median absolute improvement was greater than in studies beyond dementia which have used stronger designs with fewer risks of bias. Included studies demonstrated large variation in the effectiveness of audit and feedback. Conclusions: Whilst methodological and reporting limitations in the included studies hinder the ability to draw strong conclusions on the effectiveness of audit and feedback in dementia care, the large interquartile range indicates further work is needed to understand the factors which affect the effectiveness of this much-used intervention.

Background

Evidence-based care for people with dementia is a priority for patients, carers and clinicians (Lind, 2014), and a policy priority (Department of Health, 2012; AHRQ Strategic Plan, 2014). Yet, people with dementia do not always receive evidence-based care. Data from the U.S. suggests gaps in the delivery of evidence-based care, for example, only 31% of people with dementia met the quality indicator of having been screened for depression during the initial evaluation (Arora et al., 2007). In England and Wales, the national audit of dementia found that whilst 97% of organisations had a process in place to undertake a mental state examination, this was done in only 50% of records audited (Royal College of Psychiatrists, 2013). An earlier audit of hospitals in England and Wales (Souza et al., 2014) found that only 26% of patients with dementia had a standardised assessment of functioning. The challenge of providing evidence-based care for people with dementia is not limited to hospitals, for example, they are often prescribed anti-psychotic drugs inappropriately in care homes (AllParty Parliamentary Group on Dementia, 2008; Kheun, 2013). Audit and feedback, also known as clinical, nursing or medical audit, is a practice change intervention to increase the receipt of evidence-based care (Souza et al., 2014). Audit and feedback is widely advocated as a way to increase the use of evidence and to provide data to assess assurance of care quality. It is a requirement of professional registration (e.g. General Medical Council, 2012), of regulatory arrangements (e.g. Care Quality Commission, 2010) and has an important role in nursing care (e.g. Christina et al., 2016). Audit and feedback involves comparing current care against an evidence-based standard, and giving feedback to staff on whether that current care meets those standards. Steps in the audit process have been described as planning, standard setting, measuring performance, providing feedback, implementing change and re-auditing (Benjamin, 2008).