PHICO-Community Nursing, Population Health and Integrated Care Office, Singapore General Hospital, 10 Hospital Boulevard, SingHealth Tower, Singapore, 168582.
Health Services Research, Changi General Hospital, 2 Simei Street 3, Singapore, 529889.
Geriatr Nurs. 2022 Jul-Aug;46:69-79. doi: 10.1016/j.gerinurse.2022.04.024. Epub 2022 May 22.
The role of nurses has evolved to meet the dynamic needs of an aging population. Community nursing has been established in Singapore with the aim to anchor population health and provide sustainable healthcare services beyond the hospital to the community. Community nurses provide health services to residents at the Community Nurse Posts (CNP) situated within the heartland residential estates.
To investigate the effect on healthcare utilization six months pre and post first community nurse visit in older adults, and if the effect is modified by the presence of two or more community nurse visits or absence of a polyclinic chronic disease diagnosis.
A single-group pretest-posttest study SETTING(S): Fifty-one SingHealth CNPs at the southeast and east regions of Singapore PARTICIPANTS: Community-dwelling older adults aged ≥ 60 years, seen at any of the SingHealth CNPs between 1 April and 30 November 2019.
The number of emergency department (ED) visits, unplanned inpatient admissions, length of inpatient stay, specialist outpatient clinic (SOC) and polyclinic visits at SingHealth institutions six months from the first community nurse visit were compared to six months prior. Negative binomial generalized estimating equations were used to model healthcare utilization events, adjusting for baseline age, gender, and race.
1,600 community-dwelling participants were included, of whom 1,561 (median age of 71 years) survived the post-test period. There was a population-average 23% lower rate of ED visits (incidence rate ratio 0.77, 95% confidence interval 0.68 to 0.87, p<0.001) and 15% lower rate of unplanned inpatient admissions (0.85, 0.75 to 0.96, p=0.011). A trend towards a lower rate of inpatient length of stay and a higher rate of SOC and polyclinic visits was also observed. The reduction in acute care utilization may have been greater among adults with two or more community nurse visits. Participants with no recent polyclinic chronic disease diagnosis had a greater increase in SOC visits.
Community nursing services are associated with reduced acute care utilization, especially for older adults with two or more community nurse visits. The trend of a higher rate of SOC visits could be attributed to the community nurses' referrals for undiagnosed/ new conditions and/or treatment of suboptimal health issues. There is a potential role for community nursing towards a sustainable healthcare system.
随着人口老龄化，护士的角色不断发展以满足动态需求。社区护理在新加坡已经建立，旨在为社区居民提供健康服务，为社区提供可持续的医疗服务，以满足居民的需求。社区护士在位于中心地带的社区护士站（CNP）为居民提供健康服务。
调查老年患者首次社区护士就诊前后 6 个月内医疗保健利用情况的变化，并探讨是否存在两次或两次以上社区护士就诊或没有社区诊所慢性病诊断会影响这种变化。
单组前后测设计。
新加坡东南部和东部的 51 个 SingHealth CNP。
2019 年 4 月 1 日至 11 月 30 日期间在任何 SingHealth CNP 就诊的年龄≥60 岁的社区居住的老年人。
比较首次社区护士就诊后 6 个月与就诊前 6 个月期间 SingHealth 机构急诊就诊、非计划性住院、住院时间、专科门诊（SOC）和社区诊所就诊的次数。采用负二项广义估计方程模型，调整基线年龄、性别和种族后，对医疗保健利用事件进行建模。
共纳入 1600 名社区居住的参与者，其中 1561 名（中位年龄为 71 岁）在测试后阶段存活。急诊就诊率平均降低了 23%（发病率比 0.77，95%置信区间 0.68 至 0.87，p<0.001），非计划性住院率降低了 15%（0.85，0.75 至 0.96，p=0.011）。住院时间和 SOC 就诊率的下降趋势也有所观察。接受两次或两次以上社区护士就诊的成年人，急性护理利用率的降低可能更大。近期无社区诊所慢性病诊断的患者，SOC 就诊率的增加更为显著。
社区护理服务与急性护理利用率的降低相关，尤其是对于接受两次或两次以上社区护士就诊的老年人。SOC 就诊率升高的趋势可能归因于社区护士对未确诊/新疾病的转诊和/或治疗亚临床健康问题。社区护理在可持续医疗体系中可能具有一定的作用。
