在全科医生护理中的连续性和违规性及其与慢性病患者死亡率的关联:使用挪威注册数据的观察性研究
Sahar Pahlavanyali1, Øystein Hetlevik1, Valborg Baste2
1Department of Global Public Health and Primary Care, University of Bergen, Bergen.
概括
与常规GP (RGP) 保持护理连续性与慢性疾病患者的死亡率降低有关. 即使患者改变了他们的RGP,连续性的好处仍然存在,这表明了强大的护理系统.
科学领域:
- 初级保健研究研究初级保健研究
- 医疗保健服务研究 医疗服务研究
- 流行病学 流行病学
背景情况:
- 定期全科医生 (RGP) 的护理连续性提供了许多好处,但在全球范围内正在下降.
- 了解影响RGP连续性的因素对于保持高质量的初级保健至关重要.
研究的目的:
- 在个人列表系统中调查RGP连续性和慢性病患者的死亡率之间的关联.
- 检查RGP连续性的变化如何影响喘,COPD,糖尿病和心力衰竭等疾病患者的这种关联.
主要方法:
- 一项基于注册表的观察性研究,利用挪威初级保健咨询数据.
- 通常的护理提供者 (UPC) 指数 (疾病特定和整体) 测量了连续性.
- 考克斯回归模型分析了连续性 (2013-2016) 和死亡率 (2017-2018) 之间的关联.
主要成果:
- 与疾病相关的RGP连续性较低 (UPCdisease <0.25) 与COPD患者的死亡风险增加47%有关.
- 降低连续性 (UPCdisease和UPCall) 与心力衰竭和糖尿病患者的死亡率增加相关.
- 总体连续性 (UPCall) 与结合性慢性病组的死亡率有关,即使是改变全科医生的患者.
结论:
- 较高的疾病相关和整体RGP连续性与死亡率降低有关.
- 改变常规GP并没有显著改变死亡率,这表明在维持护理连续性方面存在固有的系统益处.
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