Parker Gillian, Bhakta Padma, Lovett Caroline, Olsen Richard, Paisley Suzy, Turner David
Social Work Research & Development Unit, Alcuin College, University of York, UK.
J Health Serv Res Policy. 2006 Apr;11(2):110-9. doi: 10.1258/135581906776318947.
To review systematically randomized trials (RCTs) on the effectiveness and costs of paediatric home care.
National Health Service (NHS) Centre for Reviews and Dissemination guidelines were followed. In all, 20 electronic and other sources were searched, using specially designed strategies. Economic studies and other selected designs were included, but only RCT findings--on service use, clinical outcomes, costs, and impact on the family--are reported here. Analysis is descriptive, with pooled standard mean differences used where meta-analysis was possible.
About 1730 identified records up to August 2001 were potentially relevant. In all, 10 RCTs (24 papers) were finally included, covering five types of paediatric home care--for very low birth weight or medically 'fragile' infants, for asthma or diabetes, for technology-dependent children, for mental health, and generic home care. Paediatric home care may enhance physical and mental development for very low birth weight infants and may be cheaper but the evidence is not strong. Home care for diabetes or asthma may reduce parents' costs with some clinical but no social differences noticeable. No randomized trials for technologically dependent children were found. Home care for mental health may increase parental satisfaction with services and reduce some health service and residential care costs. Generic home care showed no clinical effects at early follow-up. Partial follow-up after five years suggested improved psychological adjustment. No cost data were available for this care model.
Despite recent expansion, research evidence from randomized trials for paediatric home care is slight, and methods used are weak in places. Paediatric home care poses practical and ethical questions that cannot be addressed by RCTs.
系统回顾关于儿科家庭护理有效性和成本的随机对照试验（RCT）。
遵循英国国家医疗服务体系（NHS）评审与传播中心的指南。总共使用专门设计的策略检索了20个电子及其他来源。纳入了经济研究和其他选定的设计，但此处仅报告RCT的结果——关于服务使用、临床结局、成本以及对家庭的影响。分析为描述性的，在可能进行荟萃分析的地方使用合并标准平均差。
截至2001年8月，约1730条已识别记录可能相关。最终共纳入10项RCT（24篇论文），涵盖五种儿科家庭护理类型——针对极低出生体重或医学上“脆弱”的婴儿、针对哮喘或糖尿病、针对依赖技术的儿童、针对心理健康以及一般家庭护理。儿科家庭护理可能会促进极低出生体重婴儿的身心发育，且可能成本更低，但证据并不充分。糖尿病或哮喘的家庭护理可能会降低家长的成本，在临床方面有一些差异，但未发现明显的社会差异。未找到针对依赖技术儿童的随机试验。心理健康的家庭护理可能会提高家长对服务的满意度，并降低一些医疗服务和住院护理成本。一般家庭护理在早期随访时未显示出临床效果。五年后的部分随访表明心理调适有所改善。此护理模式没有成本数据。
尽管近期有所扩展，但儿科家庭护理随机试验的研究证据较少，且所使用的方法在某些方面存在不足。儿科家庭护理带来了随机对照试验无法解决的实际和伦理问题。
