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与荷兰一般人群相比,居住在机构中的智障人士对外科医生非工作时间就诊的需求风险和紧迫性是否有所不同?一项基于横断面常规数据的研究。

Does risk and urgency of requested out-of-hours general practitioners care differ for people with intellectual disabilities in residential settings compared with the general population in the Netherlands? A cross-sectional routine data-based study.

机构信息

Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.

General Practitioner Cooperative Nijmegen and Boxmeer, Nijmegen, The Netherlands.

出版信息

BMJ Open. 2017 Nov 3;7(11):e019222. doi: 10.1136/bmjopen-2017-019222.

Abstract

OBJECTIVES

To investigate whether people with intellectual disabilities (ID) in residential setting were more likely than people from the general population to request out-of-hours general practitioner (GP) care and whether these requests had a similar level of urgency.

DESIGN

Cross-sectional routine data-based study.

SETTING

Two GP cooperatives providing out-of-hours primary care in an area in the Netherlands.

POPULATION

432 582 persons living in the out-of-hours service areas, of which 1448 could be identified as having an ID.

MAIN OUTCOME MEASURES

GP cooperative records of all contacts in 2014 for people with and without ID were used to calculate the relative risk of requesting care and the associated level of urgency.

RESULTS

Of the people with ID (448/1448), 30.9% requested out-of-hours GP care, whereas for the general population this was 18.4% (79 206/431 134), resulting in a relative risk of 1.7 (95% CI 1.6 to 1.8). We found a different distribution of urgency level for people with and without ID. Generally, requests for people with ID were rated as less urgent.

CONCLUSION

People with ID in residential setting were more likely to request out-of-hours GP care than the general population. The distribution of the urgency level of requests differed between the two groups. The high percentage of demands relating to people with ID requesting counselling and advice suggests that some out-of-hours GP care may be avoidable. However, more insight is needed into the nature of out-of-hours primary care requests of people with ID to direct structural and reasonable adjustments towards the improvement of health information exchange in and around-the-clock access to primary care for people with ID.

摘要

目的

调查居住在住宿环境中的智障人士(ID)是否比一般人群更有可能要求在非工作时间寻求全科医生(GP)护理,以及这些请求的紧急程度是否相似。

设计

基于横断面常规数据的研究。

设置

两家提供非工作时间初级保健的全科医生合作社,位于荷兰的一个地区。

人群

居住在非工作时间服务区域的 432582 人,其中 1448 人可以被确定为有 ID。

主要结果测量

使用 2014 年所有与 ID 患者和无 ID 患者接触的 GP 合作社记录,计算要求护理的相对风险以及相关的紧急程度。

结果

ID 患者(448/1448)中有 30.9%请求非工作时间的 GP 护理,而一般人群中这一比例为 18.4%(79206/431134),相对风险为 1.7(95%CI 1.6 至 1.8)。我们发现 ID 患者和无 ID 患者的紧急程度分布不同。一般来说,ID 患者的请求被评为不太紧急。

结论

居住在住宿环境中的 ID 患者比一般人群更有可能要求在非工作时间寻求 GP 护理。这两组人群的请求紧急程度分布不同。ID 患者的大量需求涉及咨询和建议,这表明一些非工作时间的 GP 护理可能是可以避免的。然而,需要更多地了解 ID 患者的非工作时间初级保健请求的性质,以针对改善 ID 患者的健康信息交流和提供 24 小时初级保健,进行结构和合理的调整。

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Editorial: Health inequity: from evidence to action.
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