Seddon M E, Marshall M N, Campbell S M, Roland M O
Department of Medicine, Middlemore Hospital, Auckland, New Zealand.
Qual Health Care. 2001 Sep;10(3):152-8. doi: 10.1136/qhc.0100152...
Little is known about the quality of clinical care provided outside the hospital sector, despite the increasingly important role of clinical generalists working in primary care. In this study we aimed to summarise published evaluations of the quality of clinical care provided in general practice in the UK, Australia, and New Zealand.
A systematic review of published studies assessing the quality of clinical care in general practice for the period 1995-9.
General practice based care in the UK, Australia, and New Zealand. Main outcome measures-Study design, sampling strategy and size, clinical conditions studied, quality of care attained for each condition (compared with explicit or implicit standards for the process of care), and country of origin for each study.
Ninety papers fulfilled the entry criteria for the review, 80 from the UK, six from Australia, and four from New Zealand. Two thirds of the studies assessed care in self-selected practices and 20% of the studies were based in single practices. The majority (85.5%) examined the quality of care provided for chronic conditions including cardiovascular disease (22%), hypertension (14%), diabetes (14%), and asthma (13%). A further 12% and 2% examined preventive care and acute conditions, respectively. In almost all studies the processes of care did not attain the standards set out in national guidelines or those set by the researchers themselves. For example, in the highest achieving practices 49% of diabetic patients had had their fundii examined in the previous year and 47% of eligible patients had been prescribed beta blockers after an acute myocardial infarction.
This study adopts an overview of the magnitude and the nature of clinical quality problems in general practice in three countries. Most of the studies in the systematic review come from the UK and the small number of papers from Australia and New Zealand make it more difficult to draw conclusions about the quality of care in these two countries. The review helps to identify deficiencies in the research, clinical and policy agendas in a part of the health care system where quality of care has been largely ignored to date. Further work is required to evaluate the quality of clinical care in a representative sample of the population, to identify the reasons for substandard care, and to test strategies to improve the clinical care provided in general practice.
尽管在基层医疗工作的临床通科医生所起的作用日益重要，但对于医院部门以外提供的临床护理质量却知之甚少。在本研究中，我们旨在总结已发表的关于英国、澳大利亚和新西兰全科医疗中临床护理质量的评估。
对1995 - 1999年期间评估全科医疗中临床护理质量的已发表研究进行系统综述。
英国、澳大利亚和新西兰基于全科医疗的护理。主要结局指标——研究设计、抽样策略和规模、所研究的临床病症、每种病症所达到的护理质量（与明确或隐含的护理过程标准相比较）以及每项研究的来源国。
90篇论文符合综述的纳入标准，其中80篇来自英国，6篇来自澳大利亚，4篇来自新西兰。三分之二的研究评估了自行选择的医疗机构中的护理情况，20%的研究基于单一医疗机构。大多数（85.5%）研究了慢性病护理质量，包括心血管疾病（22%）、高血压（14%）、糖尿病（14%）和哮喘（13%）。另有12%和2%的研究分别考察了预防保健和急性病护理质量。在几乎所有研究中，护理过程均未达到国家指南或研究人员自己设定的标准。例如，在表现最佳的医疗机构中，49%的糖尿病患者在前一年进行了眼底检查，47%的符合条件的患者在急性心肌梗死后接受了β受体阻滞剂治疗。
本研究对三个国家全科医疗中临床质量问题的规模和性质进行了概述。系统综述中的大多数研究来自英国，而来自澳大利亚和新西兰的论文数量较少，这使得更难就这两个国家的护理质量得出结论。该综述有助于确定医疗保健系统中一个至今很大程度上被忽视护理质量的部分在研究、临床和政策议程方面的不足之处。需要进一步开展工作，以评估具有代表性的人群样本中的临床护理质量，确定护理不达标的原因，并测试改善全科医疗中提供的临床护理的策略。
