Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, MN, USA.
J Gen Intern Med. 2011 Nov;26 Suppl 2(Suppl 2):689-96. doi: 10.1007/s11606-011-1849-8.
To conduct a systematic review to address the following key questions: (1) what interventions have been successful in improving access for veterans with reduced health care access? (2) Have interventions that have improved health care access led to improvements in process and clinical outcomes?
OVID MEDLINE, CINAHL, PsychINFO.
STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language articles published in peer-reviewed journals from 1990 to June 2010. All interventions designed to improve access to health care for US veterans that reported the impact of the intervention on perceived (e.g., satisfaction with access) or objective (e.g., travel time, wait time) access were included. APPRAISAL AND SYNTHESIS METHODS: Investigators abstracted data on study design, study quality, intervention, and impact of the intervention on access, process outcomes, and clinical outcomes.
Nineteen articles (16 unique studies) met the inclusion criteria. While there were a small number of studies in support of any one intervention, all showed a positive impact on either perceived or objective measures of access. Implementation of Community Based Outpatient Clinics (n = 5 articles), use of Telemedicine (n = 5 articles), and Primary Care Mental Health Integration (n = 6 articles) improved access. All 16 unique studies reported process outcomes, most often satisfaction with care and utilization. Four studies reported clinical outcomes; three found no differences.
Included studies were largely of poor to fair methodological quality.
Interventions can improve access to health care for veterans. Increased access was consistently linked to increased primary care utilization. There was a lack of data regarding the link between access and clinical outcomes; however, the limited data suggest that increased access may not improve clinical outcomes. Future research should focus on the quality and appropriateness of care and clinical outcomes.
进行系统评价，以解决以下关键问题：（1）哪些干预措施成功地改善了医疗服务机会有限的退伍军人的就医机会？（2）改善医疗服务机会的干预措施是否导致了过程和临床结果的改善？
OVID MEDLINE、CINAHL、PsychINFO。
研究入选标准、参与者和干预措施：1990 年至 2010 年 6 月期间在同行评议期刊上发表的英语文章。所有旨在改善美国退伍军人医疗服务机会的干预措施，包括报告干预措施对感知（如对获得服务的满意度）或客观（如旅行时间、等待时间）的影响，都被纳入研究范围。
研究人员提取了关于研究设计、研究质量、干预措施以及干预措施对获得服务、过程结果和临床结果的影响的数据。
19 篇文章（16 项独立研究）符合纳入标准。尽管有少量研究支持任何一种干预措施，但所有研究都对感知或客观的获得服务指标产生了积极影响。实施社区门诊（n = 5 篇文章）、使用远程医疗（n = 5 篇文章）和初级保健心理健康整合（n = 6 篇文章）改善了获得服务的机会。16 项独立研究均报告了过程结果，最常见的是对护理的满意度和利用率。有 4 项研究报告了临床结果；其中 3 项未发现差异。
纳入的研究在方法学质量上大多较差或一般。
干预措施可以改善退伍军人的医疗服务机会。获得服务的机会增加与初级保健利用率的增加密切相关。关于获得服务与临床结果之间的联系的数据有限；然而，有限的数据表明，增加获得服务的机会可能不会改善临床结果。未来的研究应侧重于护理质量和适宜性以及临床结果。
