综合行为健康实施和慢性疾病管理不平等:对全州数据的探索性研究
Gretchen J R Buchanan1,2, Jerica M Berge3, Timothy F Piehler4
1Redleaf Center for Family Healing, Hennepin Healthcare Research Institute, 701 Park Ave., Suite S3, Minneapolis, MN, 55415, USA. gretchen.buchanan@hcmed.org.
BMC primary care
|August 14, 2024
概括
将行为健康保健 (IBH) 整合到初级保健中,为慢性疾病管理和健康公平带来了复杂的结果. 令人惊的是,IBH整合较低的诊所具有更好的慢性疾病管理,突出了解决医疗保健不平等问题的系统变革的需要.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 健康 公平 卫生 公平
- 初级保健创新初级保健的创新
背景情况:
- 糖尿病,血管疾病和喘等慢性疾病不成比例地影响弱势群体,包括农村地区,低收入群体和种族/少数民族.
- 医疗保健不平等仍然存在,某些群体获得的资源较少或质量较差.
- 将行为健康保健 (IBH) 整合到初级保健中可以改善慢性疾病管理,但在各诊所实施情况各不相同.
研究的目的:
- 探索不同级别的IBH实施和慢性疾病管理之间的关系.
- 调查IBH的实施是否可以减轻慢性疾病护理中的医疗保健不平等.
- 了解IBH整合模式的变化如何影响慢性疾病管理结果.
主要方法:
- 利用了102个初级保健诊所的先前研究中的潜伏类分析.
- 使用多重回归来评估IBH潜伏类与慢性疾病管理不平等之间的联系.
- 应用结构方程建模来检查IBH隐性类对医疗保健不平等的调节作用.
主要成果:
- 与假设相反",低"IBH整合的诊所表现出更好的慢性疾病管理.
- 具有"强烈"和"结构性"IBH整合的诊所显示,在白人占主导地位的地区,慢性疾病管理得到了改善.
- IBH的实施水平并没有在不同患者群体中均地改善慢性疾病管理.
结论:
- IBH可能会提高护理水平,但单独解决医疗不平等问题是不够的.
- 当健康的社会决定因素较少时,IBH似乎更有效.
- 系统和政策变化对于解决慢性疾病管理中医疗保健不平等的根本原因至关重要.
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