多学科诊所如何缓解社会经济障碍,为慢性肢体威胁性缺血患者提供护理?
Drayson B Campbell1, Goutam Gutta1, Carly G Sobol2
1The Ohio State University College of Medicine, Columbus, OH; Division of Vascular Diseases and Surgery, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH.
Journal of vascular surgery
|June 21, 2024
概括
一个多学科的肢体保护计划 (LPP) 为慢性肢体威胁性缺血症 (CLTI) 的患者提供了可比的结果,即使这些患者具有显著的社会经济差异. 该LPP结构有效地解决了护理障碍,改善了弱势群体的获取和信任.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
背景情况:
- 多学科诊所改善了慢性四肢威胁性缺血 (CLTI) 的结果.
- 这些诊所对CLTI护理中的社会经济差异的影响尚不清楚.
- 传统的血管诊所和专门的肢体保护计划 (LPP) 进行了比较.
研究的目的:
- 为了比较在多学科LPP和传统诊所治疗的CLTI患者的结果.
- 探索患者在LPP和传统环境中对护理的感知障碍.
- 评估LPP减轻CLTI社会经济差异的潜力.
主要方法:
- 从871名CLTI患者接受重血管化 (2014-2023) 的983个四肢的回顾性分析.
- 按诊所类型分层 (LPP与传统),收集临床和社会经济数据 (区域贫困指数 [ADI]).
- 使用生存分析和半结构化患者访谈对结果 (死亡,MALE,通透性损失) 的比较分析.
主要成果:
- 患有LPP的患者更有可能是非白人,糖尿病患者,透析依赖者和社会经济贫困者 (较高的ADI).
- 尽管LPP患者的基线特征较差,但与传统诊所患者相比,LPP患者在死亡,MALE或通透性损失方面没有显著差异.
- 在最贫困的子组 (ADI>90) 中,传统诊所的患者比LPP患者更早地经历了通透性损失.
结论:
- 该LPP模型为CLTI患者提供了与传统诊所相似的结果,包括那些具有重大社会经济贫困的患者.
- LPP的综合护理,近距离和一致的团队解决了患者识别的障碍,如交通,访问频率和信任.
- 在服务不足的地区设立多学科诊所,并纳入以患者为中心的要素,可以减轻对CLTI结果的社会经济影响.
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