University of South Australia, Adelaide, SA.
Med J Aust. 2012 Jul 16;197(2):100-5. doi: 10.5694/mja12.10510.
To determine the percentage of health care encounters at which a sample of adult Australians received appropriate care (ie, care in line with evidence-based or consensus-based guidelines).
DESIGN, SETTING AND PARTICIPANTS: Computer-assisted telephone interviews and retrospective review of the medical records (for 2009-2010) of a sample of at least 1000 Australian adults to measure compliance with 522 expert consensus indicators representing appropriate care for 22 common conditions. Participants were selected from households in areas of South Australia and New South Wales chosen to be representative of the socioeconomic profile of Australians. Health care encounters occurred in health care practices and hospitals with general practitioners, specialists, physiotherapists, chiropractors, psychologists and counsellors.
Percentage of health care encounters at which the sample received appropriate care.
From 15 292 households contacted by telephone, 7649 individuals agreed to participate, 3567 consented, 2638 proved eligible, and 1154 were included after gaining the consent of their health care providers. The adult Australians in this sample received appropriate care at 57% (95% CI, 54%-60%) of 35 573 eligible health care encounters. Compliance with indicators of appropriate care at condition level ranged from 13% (95% CI, 1%-43%) for alcohol dependence to 90% (95% CI, 85%-93%) for coronary artery disease. For health care providers with more than 300 eligible encounters each, overall compliance ranged from 32% to 86%.
Although there were pockets of excellence and some aspects of care were well managed across health care providers, the consistent delivery of appropriate care needs improvement, and gaps in care should be addressed. There is a need for national agreement on clinical standards and better structuring of medical records to facilitate the delivery of more appropriate care.
确定一定比例的澳大利亚成年人在接受医疗服务时能够获得适当的医疗服务（即符合循证或共识指南的医疗服务）。
设计、地点和参与者：对至少 1000 名澳大利亚成年人进行计算机辅助电话访谈和回顾性病历审查（2009-2010 年），以衡量 522 项专家共识指标的符合率，这些指标代表 22 种常见疾病的适当治疗。参与者是从南澳大利亚和新南威尔士州选择的具有代表性的澳大利亚社会经济状况的家庭中选出的。医疗服务发生在普通科医生、专科医生、物理治疗师、脊医、心理学家和顾问的医疗服务场所和医院。
接受适当治疗的医疗服务比例。
通过电话联系了 15292 户家庭，其中 7649 户同意参与，3567 户同意，2638 户符合条件，在获得医疗服务提供者同意后，有 1154 户纳入研究。在 35573 次符合条件的医疗服务中，该样本中的澳大利亚成年人有 57%（95%可信区间，54%-60%）接受了适当的治疗。在疾病层面，适当治疗指标的符合率从酒精依赖症的 13%（95%可信区间，1%-43%）到冠状动脉疾病的 90%（95%可信区间，85%-93%）不等。对于每个提供者有 300 次以上符合条件的就诊的情况，总体符合率从 32%到 86%不等。
尽管在医疗服务提供者中有一些优秀的领域，并且一些方面的治疗管理得很好，但仍需要改进一致提供适当治疗的能力，并应解决治疗方面的差距。需要在全国范围内就临床标准达成一致，并更好地构建病历，以促进提供更适当的治疗。
