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慢性病医院门诊治疗患者未就诊率及预测因素:一项基于登记的队列研究。

Rate and predictors for non-attendance of patients undergoing hospital outpatient treatment for chronic diseases: a register-based cohort study.

作者信息

Wolff Donna Lykke, Waldorff Frans Boch, von Plessen Christian, Mogensen Christian Backer, Sørensen Thomas Lund, Houlind Kim Christian, Bogh Søren Bie, Rubin Katrine Hass

机构信息

Hospital of Southern Denmark, DK-6200, Aabenraa, Denmark.

Department of Regional Health Research, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark.

出版信息

BMC Health Serv Res. 2019 Jun 14;19(1):386. doi: 10.1186/s12913-019-4208-9.

Abstract

BACKGROUND

Failure to keep medical appointments results in inefficiencies and, potentially, in poor outcomes for patients. The aim of this study is to describe non-attendance rate and to investigate predictors of non-attendance among patients receiving hospital outpatient treatment for chronic diseases.

METHODS

We conducted a historic, register-based cohort study using data from a regional hospital and included patients aged 18 years or over who were registered in ongoing outpatient treatment courses for seven selected chronic diseases on July 1, 2013. A total of 5895 patients were included and information about their appointments was extracted from the period between July 1, 2013 and June 30, 2015. The outcome measure was occurrence of non-attendance. The associations between non-attendance and covariates (age, gender, marital status, education level, occupational status, specific chronic disease and number of outpatient treatment courses) were investigated using multivariate logistic regression models, including mixed effect.

RESULTS

During the two-year period, 35% of all patients (2057 of 5895 patients) had one or more occurrences of non-attendance and 5% of all appointments (4393 of 82,989 appointments) resulted in non-attendance. Significant predictors for non-attendance were younger age (OR 4.17 for 18 ≤ 29 years as opposed to 80+ years), male gender (OR 1.35), unmarried status (OR 1.39), low educational level (OR 1.18) and receipt of long-term welfare payments (OR 1.48). Neither specific diseases nor number of treatment courses were associated with a higher non-attendance rate.

CONCLUSIONS

Patients undergoing hospital outpatient treatments for chronic diseases had a non-attendance rate of 5%. We found several predictors for non-attendance but undergoing treatment for several chronic diseases simultaneously was not a predictor. To reduce non-attendance, initiatives could target the groups at risk.

TRIAL REGISTRATION

This study was approved by the Danish Data Protection Agency (Project ID 18/35695 ).

摘要

背景

未能按时赴约就诊会导致效率低下,还可能给患者带来不良后果。本研究旨在描述未就诊率,并调查接受医院慢性病门诊治疗患者的未就诊预测因素。

方法

我们利用一家地区医院的数据进行了一项基于登记的历史性队列研究,纳入了2013年7月1日正在接受七种选定慢性病门诊治疗的18岁及以上患者。共纳入5895例患者,并提取了他们在2013年7月1日至2015年6月30日期间的预约信息。结局指标为未就诊的发生情况。使用包括混合效应的多变量逻辑回归模型研究未就诊与协变量(年龄、性别、婚姻状况、教育水平、职业状况、特定慢性病和门诊治疗疗程数)之间的关联。

结果

在两年期间,所有患者中有35%(5895例患者中的2057例)有一次或多次未就诊情况,所有预约中有5%(82989次预约中的4393次)导致未就诊。未就诊的显著预测因素包括年龄较小(18≤29岁与80岁以上相比,比值比为4.17)、男性(比值比为1.35)、未婚状态(比值比为1.39)、低教育水平(比值比为1.18)和领取长期福利金(比值比为1.48)。特定疾病和治疗疗程数均与较高的未就诊率无关。

结论

接受医院慢性病门诊治疗的患者未就诊率为5%。我们发现了几个未就诊的预测因素,但同时患有多种慢性病并非预测因素。为减少未就诊情况,可针对高危群体采取措施。

试验注册

本研究经丹麦数据保护局批准(项目编号18/35695)。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/af62/6570866/744ecca17470/12913_2019_4208_Fig1_HTML.jpg

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