Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
BMJ Open. 2022 Jan 7;12(1):e054348. doi: 10.1136/bmjopen-2021-054348.
Evidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals.
Multicentre cross-sectional study.
A total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals).
Adult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person.
Polypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH).
Data were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant.
Clinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.
国际上支持初级保健结构对患有复杂多重疾病患者的护理质量影响的证据很少，而患有复杂多重疾病的患者是初级保健面临的最重要挑战之一。本研究旨在调查不同类型的初级保健机构与复杂多重疾病患者的多种药物治疗和患者报告指标之间的关联，重点关注社区诊所和医院之间的差异。
多中心横断面研究。
共有 25 个初级保健机构（19 个社区诊所和 6 个中小型医院）。
患有复杂多重疾病的成年门诊患者，该疾病定义为一个人同时患有三种或更多种影响三个或更多不同身体系统的慢性疾病。
多种药物治疗，使用日本版初级保健评估工具简化版（JPCAT-SF）的患者报告体验测量和自我报告健康状况（SRH）的患者报告结果测量。
对 492 名患有复杂多重疾病的患者进行了数据分析。在调整了可能的混杂因素和机构内的聚类后，与基于医院的初级保健实践相比，基于诊所的初级保健实践与较低的多种药物治疗患病率、协调和社区导向方面的 JPCAT-SF 评分较高以及较差或较差的 SRH 患病率较低相关。相比之下，基于诊所的实践中首次接触的 JPCAT-SF 评分明显较低。初级保健机构类型与 JPCAT-SF 评分在纵向性和全面性方面的关联没有统计学意义。
与基于医院的初级保健实践相比，基于诊所的初级保健实践与复杂多重疾病患者的多种药物治疗患病率较低、协调和社区导向方面的患者体验较好以及 SRH 较好相关。在初级保健环境中，规模较小且紧密的团队可能会提高患有复杂多重疾病患者的护理质量。
