医疗保健的碎片化,多病症,可能不合适的药物和死亡率:丹麦全国性队列研究
Anders Prior1,2, Claus Høstrup Vestergaard3, Peter Vedsted3,4
1Research Unit for General Practice, Bartholins Allé 2, 8000, Aarhus C, Denmark. anders.prior@ph.au.dk.
BMC medicine
|August 14, 2023
概括
分散的医疗保健增加了多种疾病患者的药物错误和死亡风险. 保持与常规提供者的护理连续性可以改善患者的治疗结果,无论疾病的严重程度如何.
科学领域:
- 医疗保健管理的管理
- 公共卫生 公共卫生
- 临床信息学 临床信息学
背景情况:
- 患有多种慢性疾病 (多重疾病) 的患者经常与医疗保健系统互动.
- 在不同的医疗保健部门进行分散的护理可能会导致患者的治疗不够优.
- 之前的研究还没有在全国范围内研究护理的分散性.
研究的目的:
- 量化护理的碎片化使用各种措施在全国范围内队列.
- 分析护理碎片化与患者结果之间的关联,包括可能不适当的药物和全因死亡率.
主要方法:
- 一项全国范围内对470万丹麦成年人进行的队列研究,使用从2018年起的医疗保健登记册.
- 包括所有初级保健和医院联系人.
- 评估临床碎片化指标 (例如提供者数量,过渡) 和正式碎片化指数.
- 根据人口统计,社会经济因素和病率水平进行统计调整.
主要成果:
- 较高的发病率水平与医疗保健提供者和转型人数的增加有关.
- 研究人员发现,高水平护理的碎片化与潜在不合适药物治疗和全因死亡率的增加之间存在显著的联系.
- 观察到的最强的关联是与众多的接触/医院轨迹以及与通常提供者的连续性较低.
结论:
- 护理碎片化的临床指标与发病率水平有关.
- 护理碎片化与患者不良结果有关,即使经过对混因素进行调整.
- 护理的连续性,更少的过渡和更好的协调与所有发病率水平的改善结果有关.
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