Boston N K, Boynton P M, Hood S
Department of R&D, Kensington & Chelsea and Westminster Health Authority, 50 Eastbourne Terrace, London W2 6LX, UK.
Fam Pract. 2001 Apr;18(2):141-8. doi: 10.1093/fampra/18.2.141.
GP units are generally nurse-led wards, where GPs have direct admitting rights and retain clinical responsibility for their patients. While GP-led wards are not new, they are relatively uncommon in urban areas. In addition, there has been little comparative evaluation of this type of service.
The aim of the present study was to compare patients admitted to an inner city GP unit with comparable patients in conventional care (e.g. district nursing, nursing/residential homes, acute care of the elderly wards) in terms of mental and physical functioning, use of health and social services and patient satisfaction.
Study group patients were those admitted to the GP unit; comparison group patients were identified by GP practices or conventional services who had agreed to participate in the study. Suitable patients were aged 65 years or over and fitted the eligibility criteria for the GP unit. Patients were interviewed at three time points: admission to either the GP unit or conventional care, and at 1 and 3 months after admission. Baseline comparability was assessed by demographic and medical data, cognitive function, mental state, social support, use of health and social services, and mental and physical functioning (SF-12). Mental and physical functioning and use of health and social services were compared between the groups over time. Patient satisfaction with their care was also compared between groups.
Change in the mental and physical functioning between patients on the GP unit (n = 67) and those in conventional care (n = 60) did not differ when the groups were compared at any of the three time points. However, the mental function of patients in the GP unit significantly improved between admission and 1 month after admission (P: < 0.05). This effect was not sustained at 3 months after admission. GP unit patients were consistently more positive about the care they received than patients receiving conventional care; this included communication and information, staff, care and the facilities. Both groups of patients were high users of health and social services, with similar patterns of use in both groups, which did not alter over time.
Patients who received care on the GP unit experienced a similar physical outcome to patients in conventional settings; however, they appeared to enjoy a short-term improvement in mental functioning and were consistently more positive about the quality of their care. This study has important policy implications with regard to planning future intermediate care services and will be of particular interest to health service planners and those responsible for clinical governance.
全科医生（GP）病房通常由护士主导，全科医生在此拥有直接收治权并对其患者保留临床责任。虽然由全科医生主导的病房并非新生事物，但在城市地区相对少见。此外，对这类服务的比较评估较少。
本研究的目的是比较入住市中心全科医生病房的患者与接受传统护理（如地区护理、护理院/养老院、老年急性护理病房）的类似患者在心理和身体功能、健康和社会服务利用情况以及患者满意度方面的差异。
研究组患者为入住全科医生病房的患者；对照组患者由同意参与研究的全科医生诊所或传统服务机构确定。合适的患者年龄在65岁及以上，符合全科医生病房的入选标准。在三个时间点对患者进行访谈：入住全科医生病房或接受传统护理时，以及入住后1个月和3个月。通过人口统计学和医学数据、认知功能、精神状态、社会支持、健康和社会服务利用情况以及心理和身体功能（SF - 12）评估基线可比性。比较两组患者随时间推移在心理和身体功能以及健康和社会服务利用情况方面的差异。还比较了两组患者对护理的满意度。
在三个时间点中的任何一个时间点比较时，全科医生病房的患者（n = 67）和接受传统护理的患者（n = 60）在心理和身体功能方面的变化没有差异。然而，全科医生病房的患者在入院后1个月时心理功能显著改善（P：< 0.05）。入院3个月后这种效果未持续。与接受传统护理的患者相比，全科医生病房的患者对所接受护理的评价一直更为积极；这包括沟通与信息、工作人员、护理和设施。两组患者都是健康和社会服务的高使用者，两组的使用模式相似，且未随时间改变。
在全科医生病房接受护理的患者与在传统环境中的患者身体状况相似；然而，他们似乎在心理功能方面有短期改善，并且对护理质量一直更为满意。这项研究对于规划未来的中间护理服务具有重要的政策意义，卫生服务规划者以及负责临床治理的人员将对此特别感兴趣。
