预测英国专科体重管理服务就诊率和完成率的患者及诊所特征：一项横断面研究。
Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study.
作者信息
Blane David N, McLoone Philip, Morrison David, Macdonald Sara, O'Donnell Catherine A
机构信息
General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
Public Health, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
出版信息
BMJ Open. 2017 Nov 20;7(11):e018286. doi: 10.1136/bmjopen-2017-018286.
OBJECTIVE
To determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS).
DESIGN
Cross-sectional study.
SETTING
Regional specialist WMS located in the West of Scotland.
PARTICIPANTS
9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing.
PRIMARY AND SECONDARY OUTCOME MEASURES
Primary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions.
ANALYSIS
Multilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion.
RESULTS
Approximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18-24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30-35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas.
CONCLUSIONS
There was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation.
目的
确定患者及转诊医疗机构特征与专科健康服务体重管理服务（WMS）的就诊率及完成率之间的关联。
设计
横断面研究。
地点
位于苏格兰西部的地区专科WMS。
参与者
2012年至2014年间转诊的9677名肥胖成年人；3250人就诊，2252人完成治疗。
主要和次要结局指标
主要结局指标是WMS的就诊率；次要结局是完成治疗，定义为就诊四次或更多次。
分析
构建多水平二元逻辑回归模型以确定患者及医疗机构特征与就诊率及完成率之间的关联。
结果
在转诊的9677名肥胖成年人中，约三分之一至少就诊过一次（n = 3250，33.6%）；只有2252人（23%）通过就诊四次或更多次完成了治疗。各医疗机构的转诊人数从1至257不等。患者层面的特征是就诊率的最强预测因素；就诊几率随年龄增加而升高（65岁及以上成年人与18 - 24岁成年人相比，比值比为4.14，95%置信区间为3.27至5.26）、体重指数（BMI）类别（BMI 45及以上与BMI 30 - 35相比，比值比为1.83，95%置信区间为1.56至2.15）以及富裕程度增加（比值比为1.96，95%置信区间为1.17至3.28）。与就诊率最密切相关的医疗机构层面特征是不属于培训型医疗机构、患者名单规模较大且不在最贫困地区。
结论
全科医疗转诊率差异很大，这表明在提高初级保健从业者对体重管理的参与度方面仍有很多工作要做。从转诊到就诊以及从就诊到完成治疗的高流失率表明患者仍面临持续障碍，尤其是那些来自社会经济最贫困地区的患者。患者及医疗机构层面的特征有助于我们理解全科医生（GP）转诊后专科WMS就诊率的观察差异，这些差异的潜在原因值得进一步研究。
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