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初级保健实践中患者团队合作的实施:来自 EvidenceNOW 西南的研究结果。

Primary Care Practices' Implementation of Patient-Team Partnership: Findings from EvidenceNOW Southwest.

机构信息

From Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora (TLH, KEK, DEN, EWS, LMD, WPD); Office for Community Health, University of New Mexico Health Sciences Center, Albuquerque (CN); Department of Family & Community Medicine, University of New Mexico, Albuquerque (RLR).

出版信息

J Am Board Fam Med. 2019 Jul-Aug;32(4):490-504. doi: 10.3122/jabfm.2019.04.180361.

Abstract

INTRODUCTION

Care teams partnering with patients are integral to quality primary care. Effective patient-team partnership recognizes patients' contributions in decision-making and respecting patients' goals and social context. We report practice characteristics associated with greater patient-team partnership scores.

METHODS

EvidenceNOW Southwest was a multistate initiative to improve cardiovascular care in primary care practices through guideline-concordant aspirin use, blood pressure control, cholesterol management, and smoking cessation. EvidenceNOW Southwest provided 9 months of practice facilitation and information technology support through regular meetings and training to 211 Colorado and New Mexico primary care practices from 2015 to 2017. We analyzed surveys from 97% of participating practices regarding patient-team partnership activities of self-management support, social need assessment, resource linkages, and patient input. We used linear and mixed effects regression modeling to examine relationships between patient-team partnership and practice characteristics.

RESULTS

Practice characteristics significantly associated with greater patient-team partnership were using patient registries, medically underserved area designation, multispecialty mix, and using clinical cardiovascular disease management guidelines. Our findings suggest that patient-team partnership implementation in small primary care practices is moderate, with mean practice- and member-level scores of 52 of 100 (range, 0-100) and 71 of 100 (range, 10-100), respectively.

CONCLUSION

Practices can improve efforts to partner with patients to assess social needs, gather meaningful input on practice improvement and patient experience, and offer resource connections. Our findings supplement recent evidence that patient registries and evidence-based guidelines may effectively prevent and manage cardiovascular disease. These strategies may also promote primary care patient-team partnership.

摘要

简介

与患者合作的医疗团队是优质初级保健的重要组成部分。有效的医患合作关系承认患者在决策中的贡献,并尊重患者的目标和社会背景。我们报告了与更高的医患合作评分相关的实践特征。

方法

EvidenceNOW Southwest 是一项多州倡议,旨在通过一致使用阿司匹林、控制血压、管理胆固醇和戒烟来改善初级保健实践中的心血管护理。从 2015 年到 2017 年,EvidenceNOW Southwest 通过定期会议和培训,为 211 家科罗拉多州和新墨西哥州的初级保健实践提供了 9 个月的实践促进和信息技术支持。我们分析了参与实践的 97%的调查,这些调查涉及自我管理支持、社会需求评估、资源联系和患者投入等医患合作活动。我们使用线性和混合效应回归模型来研究医患合作与实践特征之间的关系。

结果

与更高的医患合作显著相关的实践特征是使用患者登记系统、医疗服务不足地区指定、多专业混合以及使用临床心血管疾病管理指南。我们的发现表明,小型初级保健实践中的医患合作实施情况中等,平均实践和成员得分分别为 100 分中的 52 分(范围为 0-100)和 71 分(范围为 10-100)。

结论

实践可以改善与患者合作的努力,以评估社会需求、收集关于实践改进和患者体验的有意义的意见,并提供资源联系。我们的发现补充了最近的证据,即患者登记系统和基于证据的指南可能有效地预防和管理心血管疾病。这些策略还可能促进初级保健医患合作。

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