一般实践中的连续性护理与因门诊护理敏感情况而住院的关联：基于常规收集的个人层面数据的横断面研究。

Association between continuity of care in general practice and hospital admissions for ambulatory care sensitive conditions: cross sectional study of routinely collected, person level data.

机构信息

Data Analytics, The Health Foundation, London WC2E 9RA, UK

Data Analytics, The Health Foundation, London WC2E 9RA, UK.

出版信息

BMJ. 2017 Feb 1;356:j84. doi: 10.1136/bmj.j84.

DOI:10.1136/bmj.j84

PMID:28148478

Abstract

OBJECTIVE

To assess whether continuity of care with a general practitioner is associated with hospital admissions for ambulatory care sensitive conditions for older patients.

DESIGN

Cross sectional study.

SETTING

Linked primary and secondary care records from 200 general practices participating in the Clinical Practice Research Datalink in England.

PARTICIPANTS

230 472 patients aged between 62 and 82 years and who experienced at least two contacts with a general practitioner between April 2011 and March 2013.

MAIN OUTCOME MEASURE

Number of hospital admissions for ambulatory care sensitive conditions (those considered manageable in primary care) per patient between April 2011 and March 2013.

RESULTS

We assessed continuity of care using the usual provider of care index, which we defined as the proportion of contacts occurring between April 2011 and March 2013 that were with the most frequently seen general practitioner. On average, the usual provider of care index score was 0.61. Continuity of care was lower among practices with more doctors (average score 0.59 in large practices versus 0.70 in small practices). Higher continuity of care was associated with fewer admissions for ambulatory care sensitive conditions. When modelled, controlling for demographic and clinical patient characteristics, an increase in the usual provider of care index of 0.2 for all patients would reduce these admissions by 6.22% (95% confidence interval 4.87% to 7.55%). There was greater evidence for an association among patients who were heavy users of primary care. Heavy users also experienced more admissions for ambulatory care sensitive conditions than other patients (0.36 admissions per patient for those with ≥18 contacts with a general practitioner, compared with 0.04 admissions per patient for those with 2-4 contacts).

CONCLUSIONS

Strategies that improve the continuity of care in general practice may reduce secondary care costs, particularly for the heaviest users of healthcare. Promoting continuity might also improve the experience of patients and those working in general practice.

摘要

目的

评估与全科医生的连续性护理是否与老年患者的门诊护理敏感条件的住院有关。

设计

横断面研究。

设置

参与英格兰临床实践研究数据链接的 200 家普通实践的链接初级和二级保健记录。

参与者

230472 名年龄在 62 至 82 岁之间的患者，他们在 2011 年 4 月至 2013 年 3 月期间至少与全科医生有两次接触。

主要观察结果

2011 年 4 月至 2013 年 3 月期间每位患者的门诊护理敏感条件（被认为可在初级保健中管理的条件）住院人数。

结果

我们使用常用提供者护理指数评估护理连续性，我们将其定义为 2011 年 4 月至 2013 年 3 月期间发生的接触中与最常就诊的全科医生的接触比例。平均而言，常用提供者护理指数得分为 0.61。在医生较多的实践中连续性较低（大型实践中的平均得分 0.59 与小型实践中的 0.70）。较高的连续性与较少的门诊护理敏感条件入院相关。当进行建模并控制人口统计学和临床患者特征时，所有患者的常用提供者护理指数增加 0.2 会将这些入院减少 6.22%（95%置信区间 4.87%至 7.55%）。在初级保健的重度使用者中，这种关联的证据更大。重度使用者比其他患者经历更多的门诊护理敏感条件入院（与那些与全科医生有 2-4 次接触的患者相比，那些与全科医生有≥18 次接触的患者中，每例患者的入院次数为 0.36 次，而每例患者的入院次数为 0.04 次）。