Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México
Head of the Research Office, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México.
BMJ Open. 2022 Aug 5;12(8):e059606. doi: 10.1136/bmjopen-2021-059606.
Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective.
A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups.
Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective.
It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.
衰老伴随着多种生理变化，增加了患慢性非传染性疾病的风险。这些疾病的患病率导致了卫生服务的使用增加。卫生系统实施的护理模式应提供全面的长期医疗保健。我们进行了这项系统评价，以确定任何针对老年人的护理模式是否被证明是有效的。
系统地检索了文献，以确定评估慢性病老年患者护理模式有效性的随机临床试验。从 1966 年 1 月至 2021 年 1 月，对 MEDLINE、实践转化研究数据库、考科蓝图书馆和考科蓝对照试验中心注册库等电子数据库进行了检索。两名独立的审查员评估了研究的合格性。根据考科蓝有效实践和组织护理以及考科蓝消费者和传播小组制定的分类法，确定了干预措施并对其进行了分类。
在筛选出的 4952 条参考文献中，有 577 条可能符合条件，最终样本包括 25 项评估慢性病老年人医疗模式的研究。在 25 种护理模式中，实施最多的干预措施是教育和基于医疗保健提供的干预措施。只有 22%的干预措施的结果被确定为有效，21%的干预措施被确定为部分有效；因此，超过 50%的结果被确定为无效。
无法确定一种护理模式是有效的。模型中实施的干预措施是多变的。最有效的结果集中在干预的早期阶段改善患者与医护人员的关系。研究中涉及的干预措施与公共卫生干预措施相似，因为它们的主要目标是促进健康。大多数研究的方法学质量较低。
