General Practice Academic Unit, Graduate School of Medicine, University of Wollongong, Northfields Avenue, Wollongong, Australia.
Illawarra Health and Medical Research Institute, Northfields Avenue, Wollongong, Australia.
Fam Pract. 2022 May 28;39(3):373-380. doi: 10.1093/fampra/cmab157.
Relational continuity, 'a therapeutic relationship between a patient and provider/s that spans health care events', has been associated with improved patient outcomes.
To evaluate whether an intervention incorporating patient enrolment and a funding model for higher-risk patients influenced patient-reported experience measures, particularly relational continuity.
Cluster-randomized controlled trial over 12 months (1 August 2018-31 July 2019). Participating patients within intervention practices were offered enrolment with a preferred general practitioner, a minimum of 3 longer appointments, and review within 7 days of hospital admission or emergency department attendance. Intervention practices received incentives for longer consultations (dependent on reducing unnecessary prescriptions and tests), early post-hospital follow-up, and hospitalization reductions. The primary outcome was patient-reported relational continuity, measured by the Primary Care Assessment Tool Short Form.
A total of 774 patients, aged 18-65 years with a chronic illness or aged over 65 years, from 34 general practices in metropolitan, regional, and rural Australia across 3 states participated. Response rates for questionnaires were >90%. From a maximum of 4.0, mean baseline scores for relational continuity were 3.38 (SE 0.05) and 3.42 (SE 0.05) in control and intervention arms, respectively, with no significant between-group differences in changes pre-post trial. There were no significant changes in other patient-focussed measures.
Patient-reported relational continuity was high at baseline and not influenced by the intervention, signalling the need for caution with policies incorporating patient enrolment and financial incentives. Further research is required targeting at-risk patient groups with low baseline engagement with primary care.
关系连续性，即“患者与提供者之间跨越医疗保健事件的治疗关系”，与改善患者结局有关。
评估一项纳入患者登记和高风险患者资金模式的干预措施是否会影响患者报告的体验指标，特别是关系连续性。
为期 12 个月的整群随机对照试验（2018 年 8 月 1 日至 2019 年 7 月 31 日）。参与干预实践的患者可选择登记其首选的全科医生，至少 3 次较长的预约，并在住院或急诊就诊后 7 天内进行复查。干预实践将获得更长咨询时间（取决于减少不必要的处方和检查）、住院后早期随访和减少住院时间的奖励。主要结局是患者报告的关系连续性，通过初级保健评估工具简表进行测量。
来自澳大利亚 3 个州的 34 个大都市、地区和农村地区的 34 个普通实践中，共有 774 名年龄在 18-65 岁的慢性病患者或 65 岁以上的患者参与。问卷调查的回复率>90%。基线时，关系连续性的平均得分为 3.38（SE 0.05）和 3.42（SE 0.05），分别为对照组和干预组的最高值 4.0，试验前后两组间的变化无显著差异。其他以患者为中心的措施也没有显著变化。
基线时患者报告的关系连续性较高，且不受干预措施的影响，这表明需要谨慎对待纳入患者登记和财务激励措施的政策。需要进一步研究针对初级保健参与度低的低风险患者群体的政策。
