Department of Veterans Affairs, VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
Dell Medical School, Department of Psychiatry, The University of Texas at Austin, Austin, TX, USA.
J Gen Intern Med. 2019 May;34(Suppl 1):43-49. doi: 10.1007/s11606-019-04979-8.
Multiple comorbidities thought to be associated with poor coordination due to the need for shared treatment plans and active involvement of patients, among other factors. Cardiovascular and mental health comorbidities present potential coordination challenges relative to diabetes.
To determine how cardiovascular and mental health comorbidities relate to patient-centered coordinated care in the Department of Veterans Affairs.
This observational study used a 2 × 2 factorial design to determine how cardiovascular and mental health comorbidities are associated with patient perceptions of coordinated care among patients with type 2 diabetes mellitus as a focal condition.
Five thousand eight hundred six patients attributed to 262 primary care providers, from a national sample of 29 medical centers, who had completed an online survey of patient-centered coordinated care in the Department of Veterans Affairs (VA).
Eight dimensions from the Patient Perceptions of Integrated Care (PPIC) survey, a state-of-the-art measure of patients' perspective on coordinated and patient-centered care.
Mental health conditions were associated with significantly lower patient experiences of coordinated care. Hypotheses for disease severity were not supported, with associations in the hypothesized direction for only one dimension.
Results suggest that VA may be adequately addressing coordination needs related to cardiovascular conditions, but more attention could be placed on coordination for mental health conditions. While specialized programs for more severe conditions (e.g., heart failure and serious mental illness) are important, coordination is also needed for more common, less severe conditions (e.g., hypertension, depression, anxiety). Strengthening coordination for common, less severe conditions is particularly important as VA develops alternative models (e.g., community care) that may negatively impact the degree to which care is coordinated.
多种合并症被认为与协调不良有关，这是由于需要共同的治疗计划和患者的积极参与等因素。心血管和心理健康合并症与糖尿病相关，可能存在协调挑战。
确定心血管和心理健康合并症与退伍军人事务部以患者为中心的协调护理之间的关系。
这项观察性研究使用 2×2 析因设计来确定心血管和心理健康合并症如何与 2 型糖尿病患者的患者感知以患者为中心的协调护理相关，该患者是一个焦点条件。
来自 29 个医疗中心的全国样本中的 262 名初级保健提供者，他们隶属于 5806 名患者，这些患者完成了退伍军人事务部（VA）患者感知以患者为中心的协调护理的在线调查。
来自患者感知综合护理（PPIC）调查的 8 个维度，这是衡量患者对协调和以患者为中心的护理的观点的最新方法。
心理健康状况与协调护理的患者体验显著降低有关。疾病严重程度的假设未得到支持，仅一个维度存在与假设方向一致的关联。
结果表明，VA 可能已经充分满足了与心血管疾病相关的协调需求，但可能需要更加关注心理健康状况的协调。虽然针对更严重疾病（例如心力衰竭和严重精神疾病）的专门计划很重要，但也需要协调更常见、不太严重的疾病（例如高血压、抑郁、焦虑）。随着 VA 开发替代模型（例如社区护理），协调常见、不太严重的疾病尤为重要，这可能会对护理协调程度产生负面影响。
