经皮冠状动脉介入治疗后连续性护理及其与自我报告健康状况、临床特征和随访服务的关系。
Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention.
机构信息
Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812, Førde, Norway.
Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021, Bergen, Norway.
出版信息
BMC Health Serv Res. 2020 Jan 31;20(1):71. doi: 10.1186/s12913-020-4908-1.
AIMS
Complexity of care in patients with coronary artery disease is increasing, due to ageing, improved treatment, and more specialised care. Patients receive care from various healthcare providers in many settings. Still, few studies have evaluated continuity of care across primary and secondary care levels for patients after percutaneous coronary intervention (PCI). This study aimed to determine multifaceted aspects of continuity of care and associations with socio-demographic characteristics, self-reported health, clinical characteristics and follow-up services for patients after PCI.
METHODS
This multi-centre prospective cohort study collected data at baseline and two-month follow-up from medical records, national registries and patient self-reports. Univariable and hierarchical regressions were performed using the Heart Continuity of Care Questionnaire total score as the dependent variable.
RESULTS
In total, 1695 patients were included at baseline, and 1318 (78%) completed the two-month follow-up. Patients stated not being adequately informed about lifestyle changes, medication and follow-up care. Those experiencing poorer health status after PCI scored significantly worse on continuity of care. Patients with ST-segment elevation myocardial infarction scored significantly better on informational and management continuity than those with other cardiac diagnoses. The regression analyses showed significantly better continuity (P ≤ 0.034) in patients who were male, received written information from hospital, were transferred to another hospital before discharge, received follow-up from their general practitioner or had sufficient consultation time after discharge from hospital.
CONCLUSION
Risk factors for sub-optimal continuity were identified. These factors are important to patients, healthcare providers and policy makers. Action should be taken to educate patients, reconcile discharge plans and organise post-discharge services. Designing pathways with an interdisciplinary approach and shared responsibility between healthcare settings is recommended.
目的
由于人口老龄化、治疗方法的改进以及更专业的医疗护理，冠心病患者的医疗护理复杂性不断增加。患者在许多不同的医疗环境中接受来自各种医疗保健提供者的护理。然而，很少有研究评估经皮冠状动脉介入治疗（PCI）后患者在初级保健和二级保健之间的连续性护理。本研究旨在确定 PCI 后患者连续性护理的多方面方面及其与社会人口统计学特征、自我报告的健康状况、临床特征和随访服务的关联。
方法
这项多中心前瞻性队列研究从病历、国家登记处和患者自我报告中收集基线和两个月随访的数据。使用 Heart Continuity of Care Questionnaire 总分作为因变量进行单变量和分层回归分析。
结果
共有 1695 名患者在基线时纳入研究，其中 1318 名（78%）完成了两个月的随访。患者表示，他们没有充分了解生活方式改变、药物治疗和随访护理。那些 PCI 后健康状况较差的患者在连续性护理方面的得分明显较低。与其他心脏诊断相比，ST 段抬高型心肌梗死患者在信息和管理连续性方面的得分明显较高。回归分析显示，男性、从医院获得书面信息、出院前转院、接受全科医生随访或从医院出院后有足够的咨询时间的患者的连续性护理显著更好（P≤0.034）。
结论
确定了最佳连续性护理的风险因素。这些因素对患者、医疗保健提供者和政策制定者都很重要。应采取行动对患者进行教育、协调出院计划并组织出院后的服务。建议采用具有跨学科方法和医疗保健机构之间共同责任的路径设计。
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