Reeves David, Hann Mark, Rick Jo, Rowe Kelly, Small Nicola, Burt Jenni, Roland Martin, Protheroe Joanne, Blakeman Tom, Richardson Gerry, Kennedy Anne, Bower Peter
NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester.
Department of Public Health and Primary Care, University of Cambridge, Cambridge.
Br J Gen Pract. 2014 Sep;64(626):e568-75. doi: 10.3399/bjgp14X681385.
In the UK, the use of care planning and written care plans has been proposed to improve the management of long-term conditions, yet there is limited evidence concerning their uptake and benefits.
To explore the implementation of care plans and care planning in the UK and associations with the process and outcome of care.
A controlled prospective cohort study among two groups of patients with long-term conditions who were similar in demographic and clinical characteristics, but who were registered with general practices varying in their implementation of care plans and care planning.
Implementation of care plans and care planning in general practice was assessed using the 2009-2010 GP Patient Survey, and relationships with patient outcomes (self-management and vitality) were examined using multilevel, mixed effects linear regression modelling.
The study recruited 38 practices and 2439 patients. Practices in the two groups (high and low users of written documents) were similar in structural and population characteristics. Patients in the two groups of practices were similar in demographics and baseline health. Patients did demonstrate significant differences in reported experiences of care planning, although the differences were modest. Very few patients in the cohort reported a written plan that could be confirmed. Analysis of outcomes suggested that most patients show limited change over time in vitality and self-management. Variation in the use of care plans at the practice level was very limited and not related to patient outcomes over time.
The use of written care plans in patients with long-term conditions is uncommon and unlikely to explain a substantive amount of variation in the process and outcome of care. More proactive efforts at implementation may be required to provide a rigorous test of the potential of care plans and care planning.
在英国，有人提议使用护理计划和书面护理计划来改善长期疾病的管理，但关于其采用情况和益处的证据有限。
探讨英国护理计划和护理规划的实施情况以及与护理过程和结果的关联。
一项对照前瞻性队列研究，研究对象为两组患有长期疾病的患者，这两组患者在人口统计学和临床特征方面相似，但他们注册的全科诊所实施护理计划和护理规划的情况有所不同。
使用2009 - 2010年全科医生患者调查评估全科诊所中护理计划和护理规划的实施情况，并使用多层次混合效应线性回归模型检查与患者结果（自我管理和活力）的关系。
该研究招募了38家诊所和2439名患者。两组（书面文件高使用者和低使用者）诊所在结构和人口特征方面相似。两组诊所的患者在人口统计学和基线健康状况方面相似。尽管差异不大，但两组患者在报告的护理规划体验方面确实存在显著差异。队列中很少有患者报告有可证实的书面计划。结果分析表明，大多数患者在活力和自我管理方面随时间变化有限。诊所层面护理计划使用的差异非常有限，且与随时间变化的患者结果无关。
在患有长期疾病的患者中使用书面护理计划并不常见，也不太可能解释护理过程和结果中的大量差异。可能需要更积极的实施努力，以对护理计划和护理规划的潜力进行严格测试。
