医療従事看護師や医師が治療する患者におけるプライマリケアアウトカム: ランダム化試験
M O Mundinger1, R L Kane, E R Lenz
1School of Nursing, Columbia University, New York, NY 10032, USA. mm44@columbia.edu
JAMA
|January 13, 2000
まとめ
医療従事看護師と医師は,比較可能な初等医療の成果を提供します. このランダム化試験では,同様の健康状態とサービス利用が認められ,看護師の患者では直立血圧のコントロールがわずかに改善された.
科学分野:
- 医療サービス 研究 医療サービス
- プライマリーケア (プライマリーケア)
- 介護の実践について
背景:
- 以前の研究では,初等医療における看護師実務者 (NP) と医師の質が比較可能であることが示唆されていた.
- NPの実践を同等の独立性および患者の直接的なアウトカムデータと比較する際にはギャップが存在しました.
- NPsからプライマリーケアを受ける患者と医師の直接的なアウトカム比較の欠如.
研究 の 目的:
- 医療従事看護師または初等医療従事医師のいずれかにランダムに割り当てられた後の患者のアウトカムを比較する.
- フォローアップと継続的なケアを評価するために,緊急後の治療室または緊急ケア訪問.
主な方法:
- 1995年8月から1997年10月にかけて実施されたランダム化試験です.
- 定期的なケアを受けていない1316人の成人は,NP (n=806) または医師 (n=510) のプライマリケアにランダムに割り当てられました.
- 評価されたアウトカムには,患者の満足度,健康状態 (SF-36),生理学的測定,および6ヶ月と1年のサービス利用が含まれていました.
主要な成果:
- 6ヶ月の健康状態 (P=.92) や糖尿病 (P=.77) や喘息 (P=.82) の生理学的検査結果において有意な差異はありませんでした.
- 高血圧の看護師の患者は,統計的に有意な下位ダイアストリック血圧 (82対85mmHg;P=.04) を示しました.
- 医療サービスの利用の有意な違いはなく,全体的な満足度は同様でしたが,医師は6ヶ月で提供者の属性についてわずかに高い評価を得ました (P=.05).
結論:
- 同等なNPと医師の権限と責任を持つ ambulatory care setting で,患者のアウトカムが比較可能であった.
- この研究は,医師に似た役割と責任を持つ初等医療における看護師実務者の使用を支持しています.
- 研究結果は,看護師は,初等医療のフォローアップと継続的なケアを効果的に管理できることを示しています.
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