医疗保险受益人与肌缩性侧面硬化症的实践参数的遵守
Osvaldo J Laurido-Soto1, Irene M Faust1,2, Susan Searles Nielsen1
1Department of Neurology, Washington University School of Medicine, Saint Louis, Missouri, United States of America.
PloS one
|June 3, 2024
概括
医生对肌缩性侧面硬化症 (ALS) 临床实践参数的坚持是不理想的,特别是在黑人,老年人和社会经济弱势患者身上. 神经科医生护理显著改善了对ALS治疗指南的遵守.
科学领域:
- 神经学 神经学
- 公共卫生 公共卫生
- 医疗保健服务研究 医疗服务研究
背景情况:
- 医生遵守基于证据的临床实践参数对于优化肌缩性侧面硬化症 (ALS) 患者护理结果至关重要.
- 2009年实践参数为ALS治疗提供了指导方针,但遵守和相关因素仍未得到充分研究.
研究的目的:
- 调查美国对2009年ALS实践参数的遵守情况.
- 确定与遵守ALS治疗指南相关的社会人口和提供者特征.
主要方法:
- 在8,575名发生ALS病例的医疗保险受益人 (2009-2014) 中进行了基于人口的回顾性队列研究.
- 检查的变量包括种族/种族,性别,年龄,城市居住地,地区贫困指数 (ADI) 和提供者专业 (神经科医生与非神经科医生).
- 结果包括使用养管,非侵入性通风 (NIV),riluzole和神经科医生护理.
主要成果:
- 只有42.9%的ALS患者接受了神经科医生的护理;黑人,老年人和社会经济不利的患者接受了较少的神经科医生的护理.
- 对关键干预措施的遵守率很低:输卵管 (26.7%),NIV (19.2%) 和瑞卢 (15.3%).
- 与未接受神经科医生治疗的患者相比,接受神经科医生治疗的患者更有可能接受输卵管 (OR 2.80),NIV (OR 10.8) 和riluzole (OR 7.67).
结论:
- 神经科医生的护理与对ALS实践参数的坚持明显更高.
- 黑人,老年人和在社会经济上处于不利地位的ALS患者获得了不符合既定指导方针的低最佳护理.
- 改善对神经病学家护理的准入可能会提高对ALS治疗建议的遵守,并改善患者的治疗结果.
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