Wikström Katja, Lamidi Marja-Leena, Rautiainen Päivi, Tirkkonen Hilkka, Kivinen Petri, Laatikainen Tiina
Institute of Public Health and Clinical Nutrition, University of Eastern Finland, PO Box 1627, 70211, Kuopio, Finland.
Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland.
BMC Health Serv Res. 2021 Jan 13;21(1):65. doi: 10.1186/s12913-021-06059-2.
The need to improve the care of people with complex care requirements has been driving the reforms integrating care processes. This study examines the effect of the integration of health services on health care usage and the processes and outcomes of care among type 2 diabetes patients.
Data include all type 2 diabetes patients who lived in North Karelia, Finland, between 2014 and 2018. Health care contacts and glycated haemoglobin (HbA1c) measurements were obtained from the electronic health records. Logistic, Poisson and linear models with generalised estimating equations and the Friedman test were used to study the differences between years.
The health care usage was highest in 2017, the first year of a new organisation, and smallest in the following year. Before the new organisation, the health care usage was lowest in 2014, being slightly higher compared with 2018. Between the last two years, the mean number of contacts per person declined from 3.25 to 2.88 (-0.37, p < 0.001). The decreasing pattern seen in total health care usage was most obvious among contacts with primary health care nurses. The number of contacts increased only among specialised care nurses between the last two years. The number of HbA1c measurements was also in its lowest in 2018 but in its highest in 2015. Between the years 2014 and 2018, the difference in the mean number of contacts was - 0.05 (p = 0.011) for those not measured, -0.02 (p = 0.225) for those measured and within the target level of HbA1c, and 0.12 (p = 0.001) for those measured and not at the target level of HbA1c.
Health care integration first increased the health care usage but then brought it to a slightly lower level than before. The changes were most obvious in primary health care nurses' appointments, and no decline was observed in secondary-level care. Even though the numbers of HbA1c measurements and the proportion measured declined, measurements increased among those with poor glycaemic control. The observed changes might reflect the better targeting and more concordant services in different service units.
改善对有复杂护理需求人群的护理的必要性推动了护理流程整合改革。本研究探讨了卫生服务整合对2型糖尿病患者医疗保健使用情况以及护理流程和结果的影响。
数据包括2014年至2018年期间居住在芬兰北卡累利阿的所有2型糖尿病患者。医疗保健接触情况和糖化血红蛋白（HbA1c）测量值来自电子健康记录。使用带有广义估计方程的逻辑回归、泊松回归和线性模型以及弗里德曼检验来研究各年份之间的差异。
2017年（新组织架构的第一年）医疗保健使用量最高，次年最低。在新组织架构之前，2014年医疗保健使用量最低，与2018年相比略高。在最后两年之间，人均接触次数从3.25次降至2.88次（-0.37，p<0.001）。在与初级保健护士的接触中，总医疗保健使用量的下降模式最为明显。在最后两年之间，仅专科护理护士的接触次数有所增加。HbA1c测量次数在2018年也处于最低水平，但在2015年处于最高水平。在2014年至2018年期间，未进行测量者的平均接触次数差异为-0.05（p=0.011），测量且HbA1c处于目标水平者为-0.02（p=0.225），测量且HbA1c未处于目标水平者为0.12（p=0.001）。
卫生服务整合最初增加了医疗保健使用量，但随后使其降至略低于之前的水平。这些变化在初级保健护士预约方面最为明显，二级护理中未观察到下降。尽管HbA1c测量次数和测量比例有所下降，但血糖控制不佳者的测量次数增加了。观察到的变化可能反映了不同服务单位更好的针对性和更协调的服务。
