University of Western Ontario, Family Medicine, Suite 245, 100 Collip Circle, London, ON N6G 4X8.
Can Fam Physician. 2010 Nov;56(11):1166-74.
To evaluate a new program, Integrating Physician Services in the Home (IPSITH), to integrate family practice and home care for acutely ill patients.
Causal model, mixed-method, multi-measures design including comparison of IPSITH and non-IPSITH patients. Data were collected through chart reviews and through surveys of IPSITH and non-IPSITH patients, caregivers, family physicians, and community nurses.
London, Ont, and surrounding communities, where home care is coordinated through the Community Care Access Centre.
A total of 82 patients receiving the new IPSITH program of care (including 29 family physicians and 1 nurse practitioner), 82 non-randomized matched patients receiving usual care (and their physicians), community nurses, and caregivers.
Emergency department (ED) visits and satisfaction with care. Analysis included a process evaluation of the IPSITH program and an outcomes evaluation comparing IPSITH and non-IPSITH patients.
Patients and family physicians were very satisfied with the addition of a nurse practitioner to the IPSITH team. Controlling for symptom severity, a significantly smaller proportion of IPSITH patients had ED visits (3.7% versus 20.7%; P = .002), and IPSITH patients and their caregivers, family physicians, and community nurses had significantly higher levels of satisfaction (P < .05). There was no difference in caregiver burden between groups.
Family physicians can be integrated into acute home care when appropriately supported by a team including a nurse practitioner. This integrated team was associated with better patient and system outcomes. The gains for the health system are reduced strain on hospital EDs and more satisfied patients.
评估一项新的项目，即家庭医生综合服务计划（IPSITH），以整合家庭医生和家庭护理，为急性病患者提供服务。
因果模型、混合方法、多措施设计，包括 IPSITH 患者和非 IPSITH 患者的比较。数据通过病历回顾和 IPSITH 患者和非 IPSITH 患者、护理人员、家庭医生和社区护士的调查收集。
安大略省伦敦及周边社区，家庭护理通过社区护理准入中心协调。
共 82 名接受新 IPSITH 护理计划的患者（包括 29 名家庭医生和 1 名护士从业者）、82 名接受常规护理的非随机匹配患者（及其医生）、社区护士和护理人员。
急诊部（ED）就诊次数和护理满意度。分析包括 IPSITH 项目的过程评估和 IPSITH 患者与非 IPSITH 患者的结果评估。
患者和家庭医生对在 IPSITH 团队中增加护士从业者非常满意。在控制症状严重程度的情况下，IPSITH 患者 ED 就诊的比例显著较小（3.7%对 20.7%；P=.002），IPSITH 患者及其护理人员、家庭医生和社区护士的满意度显著更高（P<.05）。两组间护理人员负担无差异。
当家庭医生得到包括护士从业者在内的团队适当支持时，可以整合到急性家庭护理中。这种整合的团队与更好的患者和系统结果相关。对卫生系统的好处是减少医院急诊部的压力和提高患者满意度。
