复杂性在初级保健中的流行及其相关因素:新加坡的经验
Jing Sheng Quek1, Jeremy Kaiwei Lew1, Eng Sing Lee1,2
1National Healthcare Group Polyclinics, Singapore.
Annals of the Academy of Medicine, Singapore
|March 12, 2025
概括
在初级保健中,患者的复杂性正在上升,15%的遭遇是复杂的护理 (CC) 和18.5%的医疗挑战 (MC). 移动性的限制,较长的咨询时间和较低的社会经济地位显著预测了复杂性.
科学领域:
- 初级医疗保健医学 一级医疗保健医学
- 医疗保健服务研究 医疗服务研究
- 老年医学 老年医学
背景情况:
- 人口老龄化增加了患者的复杂性,要求提供更好的资源,协调的护理.
- 了解导致患者复杂性的因素对于优化医疗保健资源配置至关重要.
- 本研究调查了新加坡初级保健机构中复杂护理需求的流行率和预测因素.
研究的目的:
- 评估新加坡初级保健中复杂护理需求的普遍性.
- 确定与复杂的护理需求相关的因素.
- 为资源分配和护理协调策略提供信息.
主要方法:
- 使用定性研究设计来开发患者复杂性问卷.
- 69名家庭医生评估了患者的接触,将其分为例行护理 (RC),医疗挑战 (MC) 或复杂护理 (CC).
- 混合效应多项逻辑回归确定了复杂性的独立预测因素.
主要成果:
- 在4327次遭遇中,15.0%被归类为复杂护理 (CC),18.5%被归类为具有医疗挑战性 (MC).
- 常见的挑战包括多药,控制不良的慢性疾病,治疗相互作用,低健康素养和需要专家协调.
- 复杂性的独立预测因素是流动性限制 (OR:7.14),较长的咨询时间 (OR:3.96) 和较低的社会经济地位 (OR:2.98).
结论:
- 复杂而具有医疗挑战性的护理需求在初级保健中普遍存在.
- 仅仅依靠慢性疾病的数量不足以捕捉患者复杂性的全部范围.
- 解决移动性限制,咨询时间和社会经济因素是管理复杂护理的关键.
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