丹麦全科医疗中的慢性病管理--工作量和多种疾病的横断面研究。
Chronic care management in Danish general practice--a cross-sectional study of workload and multimorbidity.
机构信息
The Research Unit for General Practice, Aarhus University, Bartholins Alle 2, DK - 8000, Aarhus C, Denmark.
出版信息
BMC Fam Pract. 2012 Jun 7;13:52. doi: 10.1186/1471-2296-13-52.
BACKGROUND
About 30% of the Danish population has one or more chronic conditions, and general practitioners (GPs) play a key role in effective chronic care management. However, little is known about these encounters in general practice. The aim was to describe the frequency of patients with one or more chronic conditions in general practice and how these consultations were experienced by the GPs.
METHODS
All GPs in the Central Denmark Region were invited to register all contacts during one day in the 12-month study period from December; 404 (46%) accepted. For each patient contact, the GPs were asked to fill in a one-page registration form covering information on chronic disease, reason for encounter, diagnosis, number of additional psychosocial problems raised by the patient during the consultation, time consumption, experienced burden of the consultation, referral to specialized care, and whether a nurse could have substituted the GP. Patients were categorized according to the number of chronic conditions (none, one, two, three or more) and the categories compared with regard to the GP-experienced burden of the contacts. Moreover, we examined which chronic conditions posed the the greatest challenge to the GPs.
RESULTS
Patients aged 40 years or more had a total of 8,236 contacts. Among these patients 2,849 (34.6%; 95% CI 33.6-35.6) had one and 2,596 (31.5%; CI 30.5-32.5) had more than one chronic disease. The time consumption and the burden of their contacts tended to rise with the number of chronic conditions. Being present in 22.9% (CI 21.6-24.3) of all face-to-face contacts, hypertension was the most common chronic condition. The burden of the contacts was experienced as particularly heavy for patients with depression and dementia due to more additional psychosocial problems and the time consumption.
CONCLUSION
General practitioners considered consultations with multimorbid patients demanding and not easily delegated to nurses. As the number of patients with chronic conditions and multimorbidity is increasing, GPs can be expected to face a heavier workload in the future.
背景
约 30%的丹麦人口患有一种或多种慢性病，全科医生（GP）在有效的慢性病管理中发挥着关键作用。然而，人们对这些在一般实践中的遭遇知之甚少。目的是描述全科医生实践中患有一种或多种慢性病的患者的频率，以及 GP 对这些就诊的体验。
方法
邀请丹麦中部地区的所有全科医生在为期 12 个月的研究期间的 12 月的某一天登记所有接触者；有 404 名（46%）人接受了邀请。对于每一次患者接触，GP 被要求填写一页登记表，涵盖慢性病信息、就诊原因、诊断、患者在就诊期间提出的额外心理社会问题的数量、时间消耗、就诊负担、向专科护理的转介情况，以及护士是否可以替代 GP。患者根据慢性病数量（无、一、二、三或更多）进行分类，并就 GP 体验到的接触负担进行比较。此外，我们还检查了哪些慢性病对 GP 构成最大的挑战。
结果
40 岁或以上的患者共有 8236 次接触。在这些患者中，2849 人（34.6%；95%CI 33.6-35.6）患有一种慢性病，2596 人（31.5%；CI 30.5-32.5）患有多种慢性病。接触的时间消耗和负担随着慢性病数量的增加而增加。高血压在所有面对面接触中占 22.9%（CI 21.6-24.3），是最常见的慢性病。由于更多的额外心理社会问题和时间消耗，抑郁症和痴呆症患者的就诊负担被认为特别重。
结论
全科医生认为，与多种疾病患者的就诊需要花费更多时间，且不易委托给护士。随着慢性病和多种疾病患者数量的增加，未来 GP 预计将面临更繁重的工作量。
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