Parker Sharon, Fuller Jeffrey
School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, Australia.
Centre of Research Excellence in Primary Health Care Microsystems, Flinders University, Adelaide, South Australia, Australia.
Health Soc Care Community. 2016 Mar;24(2):113-22. doi: 10.1111/hsc.12194. Epub 2015 Feb 9.
Care co-ordination is reported to be an effective component of chronic disease (CD) management within primary care. While nurses often perform this role, it has not been reported if they or other disciplines are best placed to take on this role, and whether the discipline of the co-ordinator has any impact on clinical and health service outcomes. We conducted a rapid review of previous systematic reviews from 2006 to 2013 to answer these questions with a view to informing improvements in care co-ordination programmes. Eighteen systematic reviews from countries with developed health systems comparable to Australia were included. All but one included complex interventions and 12 of the 18 involved a range of multidisciplinary co-ordination strategies. This multi-strategy and multidisciplinarity made it difficult to isolate which were the most effective strategies and disciplines. Nurses required specific training for these roles, but performed co-ordination more often than any other discipline. There was, however, no evidence that discipline had a direct impact on clinical or service outcomes, although specific expertise gained through training and workforce organisational support for the co-ordinator was required. Hence, skill mix is an important consideration when employing care co-ordination, and a sustained consistent approach to workforce change is required if nurses are to be enabled to perform effective care co-ordination in CD management in primary care.
据报道，护理协调是初级保健中慢性病管理的一个有效组成部分。虽然护士经常承担这一角色，但尚未有报道表明他们或其他学科是否最适合承担这一角色，以及协调人员的学科背景对临床和卫生服务结果是否有任何影响。我们对2006年至2013年之前的系统评价进行了快速回顾，以回答这些问题，旨在为改善护理协调计划提供信息。纳入了来自与澳大利亚卫生系统相当的发达国家的18项系统评价。除一项外，所有评价均纳入了复杂干预措施，18项评价中有12项涉及一系列多学科协调策略。这种多策略和多学科性使得难以确定哪些是最有效的策略和学科。护士担任这些角色需要接受特定培训，但比任何其他学科更常进行协调工作。然而，没有证据表明学科背景对临床或服务结果有直接影响，尽管协调人员需要通过培训获得特定专业知识以及获得劳动力组织支持。因此，在采用护理协调时，技能组合是一个重要考虑因素，如果要使护士能够在初级保健的慢性病管理中进行有效的护理协调，就需要对劳动力变革采取持续一致的方法。
