Sistemes d'Informació dels Serveis d'Atenció Primària (SISAP), Institut Català de la Salut (ICS), Gran Via de Les Corts Catalanes, 587, 08007, Barcelona, Spain.
Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.
BMC Fam Pract. 2021 Mar 25;22(1):56. doi: 10.1186/s12875-021-01414-y.
There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients' sociodemographic characteristics play a role in its continuity of care.
Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut-ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices.
Indices' results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship.
Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.
有证据表明，医患关系的持续存在与改善健康结果和更高效的卫生系统有关。本研究的主要目的是描述加泰罗尼亚（西班牙）初级保健中的连续性护理，并分析初级保健实践（PCP）的组织或其患者的社会人口特征是否对其连续性护理产生影响。
使用四个指数来衡量连续性护理：常用提供者指数（UPC）、改良改良连续性指数（MMCI）、连续性护理指数（COC）和连续连续性指数（SECON）。该研究在加泰罗尼亚卫生研究所（Institut Català de la Salut-ICS）的 287 个 PCP 中进行。每个连续性护理指数均在患者水平（320 万患者和 3550 万次就诊）上进行计算，然后在 PCP 水平上进行汇总。我们为每个研究的连续性指数调整了线性回归模型，将指数结果作为因变量，将 PCP 的人口统计学和组织特征作为解释变量。使用 Pearson 相关检验比较了四种连续性护理指数。
指数结果为：UPC：70.5%；MMCI：73%；COC：53.7%；SECON：60.5%。连续性护理指数与预约时与指定卫生提供者的预约百分比（VISUBA 变量：值越低，没有指定卫生提供者的就诊次数越高，因此组织更倾向于即时咨询）具有最高的双变量相关性。其 R 范围在 56%到 63%之间，具体取决于指数。更好地解释连续性护理指数变异性的多变量模型（从 49%到 56%）包括与直接关系的 VISUBA 和农村性变量；而初级保健医生休假天数和培训实践的变量则显示出相反的关系。
研究结果表明，促进即时咨询的初级保健组织与较低的患者护理连续性有关。
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