成年人预防保健服务质量：意大利南部一项横断面研究的结果。
The quality of preventive health care delivered to adults: results from a cross-sectional study in Southern Italy.
机构信息
Chair of Hygiene, Medical School, University of Catanzaro "Magna Graecia", Catanzaro, Italy.
出版信息
BMC Public Health. 2010 Jun 18;10:350. doi: 10.1186/1471-2458-10-350.
BACKGROUND
It is assumed that providing clinical preventive services to patients can identify or detect early important causes of adult mortality. The aim of this study was to quantify access to preventive services in Southern Italy and to assess whether and how the provision of preventive care was influenced by any specific characteristics of patients.
METHODS
In a cross-sectional study adults aged 18 years and over attending primary care physician (PCP) offices located in Southern Italy were interviewed from June through December 2007. Quality indicators of preventive health care developed from RAND's Quality Assessment Tools and Behavioral Risk Factor Surveillance System (BRFSS) were used. Multivariate analysis was performed to identify and to assess the role of patients' characteristics on delivery of clinical preventive services.
RESULTS
A total of 1467 subjects participated in the study. Excepting blood pressure preventive check (delivered to 64.4% of eligible subjects) and influenza vaccination (recommended to 90.2% of elderly), the rates of delivery of clinical preventive services were low across all measures, particularly for screening and counseling on health habits. Rates for providing cancer screening tests at recommended times were 21.3% for colonoscopy, 51.5% for mammography and 52.4% for Pap smear. Statistical analysis showed clear disparities in the provision of clinical preventive services associated with age, gender, education level, perceived health status, current health conditions and primary care access measures.
CONCLUSIONS
There is overwhelming need to develop and implement effective interventions to improve delivery of routine clinical preventive services.
背景
为患者提供临床预防服务被认为可以识别或发现导致成年人死亡的重要早期原因。本研究的目的是量化意大利南部预防服务的可及性，并评估预防保健的提供是否以及如何受到患者任何特定特征的影响。
方法
本研究采用横断面研究设计，于 2007 年 6 月至 12 月在意大利南部的初级保健医生（PCP）办公室对 18 岁及以上的成年人进行了访谈。使用了 RAND 质量评估工具和行为风险因素监测系统（BRFSS）开发的预防保健质量指标。采用多变量分析来确定并评估患者特征对临床预防服务提供的作用。
结果
共有 1467 名受试者参加了研究。除了血压预防性检查（提供给 64.4%的合格受试者）和流感疫苗接种（推荐给 90.2%的老年人）外，所有措施的临床预防服务提供率都较低，特别是在健康习惯筛查和咨询方面。在推荐的时间提供癌症筛查测试的比例为结肠镜检查 21.3%，乳房 X 线摄影术 51.5%，巴氏涂片检查 52.4%。统计分析显示，在提供临床预防服务方面存在明显的差异，与年龄、性别、教育水平、感知健康状况、当前健康状况和初级保健获取措施有关。
结论
迫切需要制定和实施有效的干预措施，以改善常规临床预防服务的提供。
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