在爱尔兰的一般实践中,绩效报酬是否促进了反向不平等?
Sarah Linnane1, Sarah Mullarkey1, Eoin Kyne1
1ICGP Mid West GP Training Scheme.
概括
爱尔兰的慢性疾病管理 (CDM) 计划可能会提供不平等的护理. 初步发现表明,与公共资助患者相比,私人患者对慢性疾病的管理较差.
科学领域:
- 一般实践和初级保健服务.
- 医疗保健服务研究 医疗服务研究
- 慢性疾病管理 慢性疾病管理
背景情况:
- 爱尔兰慢性疾病管理 (CDM) 计划于2020年成立,为全科医生 (GPs) 提供资源,为八种特定慢性疾病的公共 (GMS) 患者进行每年两次审查.
- 这种按绩效支付的倡议已经得到了广泛的GP采用.
- 有一种假设认为,由于相关费用,私人患者 (PP) 可能会因不愿意参加预约而获得较低的护理标准.
研究的目的:
- 评估CDM计划下的八种慢性疾病的管理标准是否在私人患者 (PP) 和GMS患者之间相当.
- 调查慢性病护理中的潜在差异,受患者资金状况的影响.
主要方法:
- 在爱尔兰中西部的GP实践中进行了追溯审计.
- 每个诊所收集了25名GMS患者和25名PP患者的数据,根据年龄,性别和临床状况进行匹配,每个患者至少患有八种特定慢性疾病中的一种.
- 评估的关键参数包括疫苗接种状态 (流感,肺炎球菌,COVID-19),BMI,血压,吸烟状态,功能,HbA1c,脂质概况,心力衰竭患者的BNP,以及COPD/喘患者的肺功能. 接种COVID-19疫苗的情况作为对照.
主要成果:
- 两家全科医生实践的初步结果表明,PP和GMS患者在大多数参数的管理中存在显著和一致的差异.
- 这些差异表明,基于患者的资金状况,在护理提供方面存在潜在的不平等.
结论:
- 根据年龄或收入,仅限于GMS患者的绩效支付计划可以加剧健康不平等.
- 该研究倡导将慢性疾病管理护理扩展到所有患者,无论他们的资金状况如何,以确保公平的医疗保健准入和结果.
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