在初级保健中关于与酒精有关的问题的实践层次文档
Elizabeth Needham Waddell1, George S Leibowitz2, Levi N Bonnell3
1OHSU-PSU School of Public Health & OHSU School of Medicine, Oregon Health & Science University, Portland.
JAMA network open
|October 19, 2023
概括
在初级保健实践中,较高的社会贫困与较少记录的与酒精有关的问题有关. 这凸显了对酒精使用障碍治疗的差异,特别是在弱势地区.
科学领域:
- 公共卫生 公共卫生
- 主要护理医学 医疗保健
- 医疗保健服务研究 医疗服务研究
背景情况:
- 与酒精相关的死亡人数有所上升,在2019年至2020年之间出现了显著的增加.
- 年长的成年人 (55-64岁) 面临的最高率,往往是由于酒精性肝病和精神疾病.
- 在电子健康记录中记录与酒精有关的问题的地理差异可能导致酒精使用障碍的治疗不足.
研究的目的:
- 调查在初级保健电子健康记录中关于酒精相关问题的文档的地理差异.
- 检查实践层面的社会贫困与与酒精有关的问题的记录之间的联系.
主要方法:
- 一项横截面研究利用了44个初级保健实践的二次数据 (2017年9月至2021年1月).
- 在实践层面上使用了社会贫困指数 (SDI),这是社会经济因素的综合衡量标准.
- 通过ICD代码或药物使用确定了与酒精有关的问题的文档;多变量模型根据患者和实践特征进行调整.
主要成果:
- 总共有3105名参与者被分析,平均年龄为63.7岁;6%的人有记录的与酒精有关的问题.
- 较高的实践水平社会贫困指数 (SDI) 分数与记录与酒精有关的问题的几率相反相关 (OR,0.89;95% CI,0.800.99;P=.03).
- 在对个人水平的酒精使用,人口统计和健康状况进行调整后,这种关联仍然存在.
结论:
- 在初级保健实践中增加的社会贫困与与酒精有关的问题的记录减少有关.
- 调查结果强调需要解决诊断和记录酒精使用障碍的实践层面障碍,特别是在服务不足的地区.
- 针对性培训,资源和实用工具对于高需求环境中的实践来说至关重要,以改善对复杂患者的护理.
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