定期的な診療のフォローアップの代わりとして,電話でのケア
J Wasson1, C Gaudette, F Whaley
1Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH 03755-3862.
JAMA
|April 1, 1992
まとめ
診療所への診察を電話で代替することで,医療サービスの利用率と医療費が削減されました. 病気の患者にとって,このアプローチは健康状態を改善し,死亡率を下げることもあります.
科学分野:
- プライマリーケア (プライマリーケア)
- 医療サービス 研究 医療サービス
- ゲリアトリック・メディシン (老年医学)
背景:
- 高齢者の慢性疾患の管理には,しばしば診療所への頻繁な訪問が含まれます.
- 利用とコストを削減するために医療の提供を最適化することは,プライマリケアにおける重要な課題です.
研究 の 目的:
- 臨床医が主導する電話での診療で,一部の診療所訪問を代替することで,患者の健康に悪影響を及ぼすことなく,医療サービスの利用率を減少させるという仮説を評価する.
- 高齢の男性集団における電話ケアによる経済的影響と潜在的な健康上の利点を評価する.
主な方法:
- 54歳以上の497人の男性を対象に,初等医療施設でランダム化試験が行われました.
- 介入グループは,フォローアップの間隔を2倍にし,定期的な電話連絡を伴う電話でのケアを受け,対照群は通常のケアを受けていました.
- 主なアウトカム指標には,2年間の追跡期間中の医療サービスの利用と患者の健康状態が含まれていました.
主要な成果:
- 電話対応の患者は,診療所への訪問が19%減少し,薬の使用 (14%),入院,入院日数 (28%) が著しく減少した.
- 集中治療室 (ICU) の入院日数は,電話治療グループでは41%減少した.
- 推定される医療費は,電話診療の患者では28%低く,当初健康状態が良好または不良であった患者ではより大きな節約が観察されました.
結論:
- 選択された診療所訪問の代わりに電話でのケアを行うことは,医療サービスの利用率と医療費を大幅に削減するための効果的な戦略です.
- より重症な患者では,電話によるケアにより,身体機能が改善され,潜在的に死亡率が低下する可能性があります.
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