痴呆患者的初级保健连续性和潜在可避免的住院治疗。

Primary care continuity and potentially avoidable hospitalization in persons with dementia.

机构信息

Department of Family Medicine, McGill University, Montreal, Quebec, Canada.

Department of Epidemiology, Biostatics, and Occupational Health, McGill University, Montreal, Quebec, Canada.

出版信息

J Am Geriatr Soc. 2021 May;69(5):1208-1220. doi: 10.1111/jgs.17049. Epub 2021 Feb 26.

DOI:10.1111/jgs.17049

PMID:33635538

Abstract

BACKGROUND/OBJECTIVE: To measure the association between high primary care continuity and potentially avoidable hospitalization in community-dwelling persons with dementia. Our hypothesis was that high primary care continuity is associated with fewer potentially avoidable hospitalizations.

DESIGN

Population-based retrospective cohort (2012-2016), with inverse probability of treatment weighting using the propensity score.

SETTING

Quebec (Canada) health administrative database, recording most primary, secondary and tertiary care services provided via the public universal health insurance system.

PARTICIPANTS

Population-based sample of 22,060 community-dwelling 65 + persons with dementia on March 31st, 2015, with at least two primary care visits in the preceding year (mean age 81 years, 60% female). Participants were followed for 1 year, or until death or long-term care admission.

EXPOSURE

High primary care continuity on March 31st, 2015, i.e., having had every primary care visit with the same primary care physician, during the preceding year.

MAIN OUTCOME MEASURES

Primary: Potentially avoidable hospitalization in the follow-up period as defined by ambulatory care sensitive conditions (ACSC) hospitalization (general and older population definitions), 30-day hospital readmission; Secondary: Hospitalization and emergency department visit.

RESULTS

Among the 22,060 persons, compared with the persons with low primary care continuity, the 14,515 (65.8%) persons with high primary care continuity had a lower risk of ACSC hospitalization (general population definition) (relative risk reduction 0.82, 95% CI 0.72-0.94), ACSC hospitalization (older population definition) (0.87, 0.79-0.95), 30-day hospital readmission (0.81, 0.72-0.92), hospitalization (0.90, 0.86-0.94), and emergency department visit (0.92, 0.90-0.95). The number needed to treat to prevent one event were, respectively, 118 (69-356), 87 (52-252), 97 (60-247), 23 (17-34), and 29 (21-47).

CONCLUSION

Increasing continuity with a primary care physician might be an avenue to reduce potentially avoidable hospitalizations in community-dwelling persons with dementia on a population-wide level.

摘要

背景/目的：测量初级保健连续性高与社区居住的痴呆症患者可避免住院之间的关联。我们的假设是，初级保健连续性高与可避免住院的次数较少有关。

设计

基于人群的回顾性队列研究（2012-2016 年），使用倾向评分进行治疗可能性反概率加权。

设置

魁北克（加拿大）健康行政数据库，记录通过公共全民健康保险系统提供的大多数初级、二级和三级保健服务。

参与者

2015 年 3 月 31 日，在社区居住的 65 岁及以上的痴呆症患者的基于人群的样本，在过去一年中有至少两次初级保健就诊（平均年龄 81 岁，60%为女性）。参与者随访 1 年，或直至死亡或长期护理入院。

暴露情况

2015 年 3 月 31 日，初级保健连续性高，即在过去一年中，与同一名初级保健医生进行了所有的初级保健就诊。

主要结果测量

初级保健结果：随访期间可避免的住院治疗，定义为可通过门诊护理敏感条件（ACSC）住院治疗（一般人群和老年人群定义）、30 天内再次住院；次要结果：住院和急诊就诊。

结果

在 22060 名患者中，与初级保健连续性低的患者相比，14515 名（65.8%）初级保健连续性高的患者发生 ACSC 住院治疗（一般人群定义）的风险较低（相对风险降低 0.82，95%CI 0.72-0.94）、ACSC 住院治疗（老年人群定义）（0.87，0.79-0.95）、30 天内再次住院（0.81，0.72-0.92）、住院（0.90，0.86-0.94）和急诊就诊（0.92，0.90-0.95）。预防 1 例事件所需的治疗人数分别为 118（69-356）、87（52-252）、97（60-247）、23（17-34）和 29（21-47）。