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有和无多重疾病人群中常规初级保健类型与住院治疗之间的关联:一项针对 25780 名中国人的家庭调查。

The association between types of regular primary care and hospitalization among people with and without multimorbidity: A household survey on 25,780 Chinese.

机构信息

School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.

General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland, UK.

出版信息

Sci Rep. 2016 Jul 20;6:29758. doi: 10.1038/srep29758.

Abstract

Using data collected from 25,780 Hong Kong citizens in a household survey, this study aimed to investigate the association between having regular source of primary care and hospitalization amongst people with and without multimorbidity (two or more chronic conditions). Potential interaction effects of regular primary care with multimorbidity were also examined. Results revealed a significant association between having regular source of primary care from General Practitioners and reduced hospitalization amongst respondents with multimorbidity (RR = 0.772; 95% CI = 0.667-0.894), adjusting for other potential confounding factors (i.e., socio-demographic factors and medical insurance and benefits). In contrast, having regular Specialist care was significantly associated with increased risk of hospitalization among both people with multimorbidity (RR = 1.619; 95% CI = 1.256-2.087) and without multimorbidity (RR = 1.981; 95% CI = 1.246-3.149), adjusting for potential confounders. A dose-response relationship between the number of chronic diseases and hospitalization was also observed, regardless of whether participants had regular source of primary care or not; relative risks and predicted probabilities for hospitalization were generally greater for those without regular source of primary care. Further studies are warranted to explore the role of healthcare system, informatics, organizational and practice-related factors on healthcare and functional outcomes.

摘要

本研究使用了一项针对 25780 名香港市民的家庭调查数据,旨在调查在患有和不患有多种慢性疾病(两种或以上慢性疾病)的人群中,拥有常规初级保健来源与住院之间的关系。还研究了常规初级保健与多种慢性疾病之间的潜在交互作用。研究结果表明,在患有多种慢性疾病的受访者中,拥有常规全科医生初级保健来源与降低住院率之间存在显著关联(RR=0.772;95%CI=0.667-0.894),调整了其他潜在混杂因素(即社会人口统计学因素和医疗保险和福利)。相比之下,拥有常规专科保健与患有多种慢性疾病(RR=1.619;95%CI=1.256-2.087)和不患有多种慢性疾病(RR=1.981;95%CI=1.246-3.149)的人群的住院风险显著相关,调整了潜在混杂因素。无论参与者是否有常规初级保健来源,都观察到慢性疾病数量与住院之间存在剂量-反应关系;对于没有常规初级保健来源的人,住院的相对风险和预测概率通常更高。需要进一步研究探索医疗保健系统、信息学、组织和实践相关因素对医疗保健和功能结果的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9d55/4951721/5c8326678840/srep29758-f1.jpg

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