对绩效的报酬是否会促进慢性疾病管理中的逆不平等?
Sarah Linnane1, Sarah Mullarkey1, Eoin Kyne1
1Irish College of General Practitioners Mid-West GP Training Scheme, School of Medicine Building, University of Limerick, Plassey, Limerick V94T9PX, Ireland.
Family practice
|May 12, 2025
概括
获得国家资助的通用医疗服务 (GMS) 护理的患者比私人患者 (PP) 获得了更好的慢性疾病管理. 爱尔兰的绩效支付 (P4P) 计划似乎加剧了这些差异,促进了医疗保健获得的不平等.
科学领域:
- 医疗保健政策和管理
- 公共卫生 公共卫生
- 一般实践研究研究一般实践研究.
背景情况:
- 爱尔兰运营着一个混合的公私医疗保健系统,包括通用医疗服务 (GMS) 和私人患者 (PP) 护理.
- 一个实践级的慢性疾病管理计划,利用绩效支付 (P4P) 模式,于2020年推出.
- P4P计划鼓励全科医生定期检查GMS患者的八种慢性疾病.
研究的目的:
- 调查P4P计划对GMS患者提供的护理标准的影响,与PPs相比.
- 评估接受常规护理的PP是否经历了较低的慢性疾病管理标准.
主要方法:
- 在爱尔兰的11个通用实践 (GP) 设置中进行了一项回顾性横截面研究.
- 分析了每个诊所的25名GMS和25名匹配PP患者的数据 (共550名患者).
- 关键的临床参数包括疫苗接种状态,血压,吸烟状态,功能,HbA1c和脂质水平进行了比较.
主要成果:
- 一般医疗服务 (GMS) 患者与私人患者 (PP) 相比,疫苗接种率 (流感,COVID-19,肺炎球菌) 显著更高.
- 在GMS患者中,更有可能监测基本的临床参数,包括血压,吸烟状态,功能,糖化血红蛋白和脂质.
- 所有测量的参数都显示了统计学上显著的差异 (P < .001),有利于GMS患者.
结论:
- 在爱尔兰,GMS和PP患者之间存在慢性疾病管理的实质差异.
- 目前的绩效支付 (P4P) 模式,仅限于GMS患者,无意中促进了医疗保健的不平等.
- 建议对政策进行审查,以确保为所有患者群体提供公平的慢性病护理.
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