Providing care to long-term mechanically ventilated patients in Germany – Current situation and needs for action from the perspective of health professionals / Die Versorgung langzeitbeatmeter Patienten in Deutschland – Aktuelle Situation und Handlungsbedarfe aus der Sicht von Gesundheitsberufsangeh?rigen

摘要

Background The number of patients depending on long-term invasive mechanical ventilation (IMV) has been increasing for several years. Anecdotal reports indicate heterogeneous health structures, opaque patient pathways, nontransparent and sometimes questionable practices in individual areas of care, inadequate quality standards and control mechanisms in Germany. However, there is hardly any empirical data on this topic. Aim To report findings from a qualitative study conducted as part of a complex research project to assess the appropriateness of care provided to IMV patients in Germany. Methods Thirteen semi-structured expert interviews were conducted with 22 health professionals providing care for IMV patients. The data analysis was conducted with MAXQDA according to the framework by Meuser and Nagel. Results Interviewees emphasized similar healthcare deficits. They considered health providers to be nontransparent and influenced by secondary interests. Quality of care is reported to be jeopardized by shortage of trained staff. Warranty of self-determination and participatory decision-making is not a matter of fact. Clarifying issues of sustaining life, quality of life and shaping the end of life is often ignored. The professionals are familiar with the patient pathways, allocation processes and responsibilities described in existing guidelines, but criticize the fact that they are not sufficiently binding. Accordingly, patient pathways are frequently individual results of experience-based, informal networking, and often left to chance. Conclusions The results point to a considerable need for action to reach an appropriate, integrated, patient-centered level of care for long-term IMV patients and ensure its quality.