Whole systems care for post-stroke management in older adults: exploring the options for integration of health and social care systems in China

老年人中风后管理的全系统护理：探索中国卫生和社会护理系统整合的选择

• 批准号: MR/P005195/1
• 负责人: Karina Kielmann
• 金额: $ 12.92万
• 依托单位: Queen Margaret University
• 依托单位国家: 英国
• 项目类别: Research Grant
• 财政年份: 2016
• 资助国家: 英国
• 起止时间: 2016 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=MR%2FP005195%2F1
• 关键词: Whole; systems; care; post; stroke

As a result of social and economic change over the past few decades, a number of low- and middle-income countries have rapidly ageing populations who are more vulnerable to long-term health conditions. To date, there has been little exploration of how the experiences of high-income countries that have developed models of integrated health and social care might inform strategies in low- and middle-income countries with growing numbers of older adults. This development grant seeks to build evidence towards development of a stroke care system for older adults in Guangdong Province, China. China's population is rapidly ageing, and approximately half of adults over 60 are living with chronic diseases. High blood pressure is the main risk factor for stroke which is leading cause of death and disability in the country. Family structures, levels of social support, and access to health insurance for older adults have changed due to the 'one-child policy', internal migration, and health reforms since the late 90's. Older adults in rural and urban settings have different levels of health awareness and support and seek health care differently, but overall, the care they receive is inconsistent and patchy. This project focuses on stroke care to explore how health and social systems are working to enable or hinder continuity of care for older adults with chronic disease conditions. First, we aim to distil the lessons learned from the international literature on stroke systems of care for older adults and examine their applicability in the Chinese health systems context. Second, we will conduct field research involving data collection with older adults, lay caregivers, and professional health and social care providers in an urban and a rural prefecture of Guangdong Province (Guangzhou and Meizhou respectively) to document experiences, patterns of care-seeking, and perceived needs for chronic disease management. A specific focus on stroke patients' journeys through recovery and rehabilitation will allow us to identify how the systems currently work, and to what extent they hinder or facilitate integrated care. Third, we will examine and summarise the data collected in the form of a model that illustrates how health and social care systems currently respond and interact to meet the needs of older patients who are recovering from a stroke. Finally, we will disseminate results through a participatory workshop that includes key individuals from health and social care institutions in order to discuss and make recommendations regarding the potential strategies that can integrate elements of current health and social care systems to improve the care of older stroke patients. This work will inform the development of a larger proposal that can implement and evaluate one or more of the strategies identified to support development of a stroke care system in China.

由于过去几十年的社会和经济变化，一些低收入和中等收入国家的人口迅速老龄化，他们更容易受到长期健康状况的影响。迄今为止，很少有人探讨高收入国家已经开发出综合健康和社会护理模式的经验如何为老年人数量不断增加的低收入和中等收入国家的战略提供参考。这笔发展补助金旨在为中国广东省老年人中风护理系统的发展提供证据。中国人口正在迅速老龄化，60岁以上的成年人中约有一半患有慢性病。高血压是中风的主要危险因素，而中风是该国死亡和残疾的主要原因。自 90 年代末以来，由于“独生子女政策”、国内人口流动和医疗改革，家庭结构、社会支持水平以及老年人获得医疗保险的机会发生了变化。农村和城市老年人的健康意识和支持水平不同，寻求医疗保健的方式也不同，但总体而言，他们获得的护理不一致且不完整。该项目重点关注中风护理，探讨卫生和社会系统如何努力为患有慢性病的老年人提供或阻碍护理的连续性。首先，我们的目标是从有关老年人中风护理系统的国际文献中汲取经验教训，并检验其在中国卫生系统背景下的适用性。其次，我们将在广东省的一个城市和一个农村地区（分别为广州和梅州）对老年人、非专业护理人员以及专业健康和社会护理提供者进行实地研究，收集数据，记录经验、寻求护理的模式、以及对慢性病管理的感知需求。对中风患者康复和康复过程的特别关注将使我们能够确定系统当前如何工作，以及它们在多大程度上阻碍或促进综合护理。第三，我们将以模型的形式检查和总结收集的数据，该模型说明健康和社会护理系统目前如何响应和相互作用，以满足中风康复的老年患者的需求。最后，我们将通过一个参与式研讨会传播结果，其中包括来自健康和社会护理机构的关键人物，以便讨论并提出有关潜在策略的建议，这些策略可以整合当前健康和社会护理系统的要素，以改善老年中风患者的护理。这项工作将为制定一项更大的提案提供信息，该提案可以实施和评估一项或多项已确定的战略，以支持中国中风护理系统的发展。

项目成果

Perceived challenges in delivering comprehensive care for patients following stroke: a qualitative study of stroke care providers in Guangdong Province, China.

为中风患者提供全面护理所面临的挑战：对中国广东省中风护理人员的定性研究。

• DOI: 10.1080/09638288.2020.1755896
• 发表时间: 2022
• 期刊: Disability and rehabilitation
• 影响因子: 2.2
• 作者: Wu C