Using the Functional Resonance Analysis Method to explore how elastic compression therapy is organised and could be improved from a multistakeholder perspective

Abstract

ObjectivesElastic compression stocking (ECS) therapy is an important treatment for patients with deep venous thrombosis (DVT) and chronic venous insufficiency (CVI). This study aimed to provide insight into the structure and variability of the ECS therapy process, its effects on outcomes, and to elicit improvement themes from a multiple stakeholder perspective.DesignThirty semi-structured interviews with professionals and patients were performed. The essential functions for the process of ECS therapy were extracted to create two work-as-done models using the Functional Resonance Analysis Method (FRAM). These findings were used to guide discussion between stakeholders to identify improvement themes.SettingTwo regions in the Netherlands, region Limburg and region North-Holland, including an academic hospital and a general hospital and their catchment region.ParticipantsThe interviewees were purposely recruited and included 25 healthcare professionals (ie, general practitioners, internists, dermatologists, nurses, doctor’s assistants, occupational therapists, home care nurses and medical stocking suppliers) and 5 patients with DVT or CVI.ResultsTwo FRAM models were created (one for each region). The variability of the functions and their effect on outcomes, as well as interdependencies between functions, were identified. These were presented in stakeholder meetings to identify the structure of the process and designated variable and uniform parts of the process and its outcomes. Ultimately, six improvement themes were identified: dissemination of knowledge of the entire process; optimising and standardising initial compression therapy; optimising timing to contact the medical stocking supplier (when oedema has disappeared); improving the implementation of assistive devices; harmonising follow-up duration for patients with CVI; personalising follow-up and treatment duration in patients with DVT.ConclusionsThis study provided a detailed understanding of how ECS therapy is delivered in daily practice by describing major functions and variability in performances and elicited six improvement themes from a multistakeholder perspective.

Development of a Consensus-Based Cross-Domain Protocol for the Management of Elastic Compression Stocking Therapy in Patients With Deep Venous Thrombosis and Chronic Venous Disease: A Modified Delphi Study

“…Anonymity between participants is guaranteed, which prevents bias resulting from opinions from dominant participants influencing group opinion ( 20 , 21 ). We modified the procedure for the qualitative first round as used in the classic Delphi analysis and instead used the content derived from two of our earlier performed studies in this context (a Functional Resonance Analysis method and a Realist evaluation) to develop the questionnaire ( 16 , 17 ). CREDES criteria were used to conduct and report the study ( 22 ).…”

“…We invited a panel of 56 Dutch health care professionals with a balanced representation of all professional groups involved in ECS therapy (i.e., internists, dermatologists, general practitioners, emergency room nurses, home care nurses, medical stocking suppliers, and occupational therapists) and seven patients ( 16 ). The participants included local stakeholders as well as national stakeholders to assure broad support of the consensus reached.…”

“…We performed a pre-established total of three questionnaire rounds. Each round consisted of statements classified as belonging to the four main stages of ECS therapy as identified by previous research: initial compression, the onset of ECS therapy, implementation of assistive devices, and follow-up ( 16 ). For each round, participants were asked to indicate their level of agreement on each of the statements provided on a 7-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = somewhat disagree, 4 = neutral, 5 = somewhat agree, 6 = agree, 7 = strongly agree).…”

“…This could hamper patients’ chances to maintain self-reliance during different stages of the process and, subsequently, lead to an increased workload for home care organizations. Two recent studies described the structure of ECS therapy and identified what needs to be in place to maximally support patients and health care professionals to achieve optimal patient outcomes ( 16 , 17 ). These studies indicated that there was a lack of unambiguous practical guidance regarding management decisions and collaboration among involved health care professionals in local, national, and international guidelines.…”

A realist evaluation to identify targets to improve the organization of compression therapy for deep venous thrombosis- and chronic venous disease patients

“…The organization of compression therapy is complex and involves collaboration between the patient and various healthcare professionals. There is considerable variation in how compression therapy is organized for both DVT and CVD patients [ 10 ]. In this study, this variability was found to affect patient’s chances to remain self-reliant, the advised treatment duration for DVT patients, and was expected to affect compliance with compression therapy.…”