Rumball-Smith Juliet, Wodchis Walter P, Koné Anna, Kenealy Tim, Barnsley Jan, Ashton Toni
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Suite 425, Toronto, ON M5T 3M6, Canada.
BMC Fam Pract. 2014 Sep 2;15:149. doi: 10.1186/1471-2296-15-149.
International and national bodies promote interdisciplinary care in the management of people with chronic conditions. We examine one facilitative factor in this team-based approach - the co-location of non-physician disciplines within the primary care practice.
We used survey data from 330 General Practices in Ontario, Canada and New Zealand, as a part of a multinational study using The Quality and Costs of Primary Care in Europe (QUALICOPC) surveys. Logistic and linear multivariable regression models were employed to examine the association between the number of disciplines working within the practice, and the capacity of the practice to offer specialized and preventive care for patients with chronic conditions.
We found that as the number of non-physicians increased, so did the availability of special sessions/clinics for patients with diabetes (odds ratio 1.43, 1.25-1.65), hypertension (1.20, 1.03-1.39), and the elderly (1.22, 1.05-1.42). Co-location was also associated with the provision of disease management programs for chronic obstructive pulmonary disease, diabetes, and asthma; the equipment available in the centre; and the extent of nursing services.
The care of people with chronic disease is the 'challenge of the century'. Co-location of practitioners may improve access to services and equipment that aid chronic disease management.
国际和国家机构提倡在慢性病患者管理中采用跨学科护理。我们研究了这种基于团队的方法中的一个促进因素——非医师学科在基层医疗实践中的同地办公。
作为一项使用欧洲初级保健质量与成本（QUALICOPC）调查的跨国研究的一部分，我们使用了来自加拿大安大略省和新西兰330家普通诊所的调查数据。采用逻辑和线性多变量回归模型来研究诊所内工作的学科数量与诊所为慢性病患者提供专科和预防护理能力之间的关联。
我们发现，随着非医师数量的增加，为糖尿病患者（优势比1.43，1.25 - 1.65）、高血压患者（1.20，1.03 - 1.39）和老年人（1.22，1.05 - 1.42）开设的特别诊疗时段/诊所的可用性也增加。同地办公还与慢性阻塞性肺疾病、糖尿病和哮喘的疾病管理项目的提供、中心可用设备以及护理服务范围相关。
慢性病患者的护理是“世纪挑战”。从业者的同地办公可能会改善获得有助于慢性病管理的服务和设备的机会。
