澳大利亚慢性病患者与医疗保健提供者互动和医疗保健系统导航情况：描述性调查研究。

Engagement with healthcare providers and healthcare system navigation among Australians with chronic conditions: a descriptive survey study.

机构信息

Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia

NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.

出版信息

BMJ Open. 2022 Dec 9;12(12):e061623. doi: 10.1136/bmjopen-2022-061623.

DOI:10.1136/bmjopen-2022-061623

PMID:36600342

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9743284/

Abstract

OBJECTIVES

With the rate of chronic conditions increasing globally, it is important to understand whether people with chronic conditions have the capacity to find the right care and to effectively engage with healthcare providers to optimise health outcomes.We aimed to examine associations between care navigation, engagement with health providers and having a chronic health condition among Australian adults.

DESIGN AND SETTING

This is a cross-sectional, 39-item online survey including the navigation and engagement subscales of the Health Literacy Questionnaire, completed in December 2018, in Australia. Binary variables (low/high health literacy) were created for each item and navigation and engagement subscale scores. Logistic regression analyses (estimating ORs) determined the associations between having a chronic condition and the navigation and engagement scores, while controlling for age, gender, level of education and income.

PARTICIPANTS

1024 Australians aged 18-88 years (mean=46.6 years; 51% female) recruited from the general population.

RESULTS

Over half (n=605, 59.0%) of the respondents had a chronic condition, mostly back pain, mental disorders, arthritis and asthma. A greater proportion of respondents with chronic conditions had difficulty ensuring that healthcare providers understood their problems (32.2% vs 23.8%, p=0.003), having good discussions with their doctors (29.1% vs 23.5%, p=0.05), discussing things with healthcare providers until they understand all they needed (30.5% vs 24.5%, p=0.04), accessing needed healthcare providers (35.7% vs 29.7%, p=0.05), finding the right place to get healthcare services (36.3% vs 29.2%, p=0.02) and services they were entitled to (48.3% vs 40.6%, p=0.02), and working out what is the best healthcare for themselves (34.2% vs 27.7%, p=0.03). Participants with chronic conditions were 1.5 times more likely to have low scores on the engagement (adjusted OR=1.48, p=0.03, 95% CI 1.05 to 2.08) and navigation (adjusted OR=1.43, p=0.026, 95% CI 1.043 to 1.970) subscales after adjusting for age, gender, income and education.

CONCLUSION

Upskilling in engagement and communication for healthcare providers and people with chronic conditions is needed. Codesigned, clearly articulated and accessible information about service entitlements and pathways through care should be made available to people with chronic conditions. Greater integration across health services, accessible shared health records and access to care coordinators may improve navigation and engagement.

摘要

目的

随着全球慢性疾病发病率的上升，了解患有慢性疾病的人是否有能力找到合适的护理，并与医疗保健提供者有效合作，以优化健康结果，这一点非常重要。我们旨在研究澳大利亚成年人中护理导航、与医疗服务提供者的互动与患有慢性健康问题之间的关联。

设计和设置

这是一项横断面、39 项的在线调查，包括健康素养问卷的导航和参与子量表，于 2018 年 12 月在澳大利亚完成。为每个项目和导航及参与子量表创建了二分变量（低/高健康素养）。使用逻辑回归分析（估计比值比），在控制年龄、性别、教育程度和收入的情况下，确定了患有慢性疾病与导航和参与得分之间的关联。

参与者

1024 名年龄在 18-88 岁（平均年龄为 46.6 岁；51%为女性）的澳大利亚人，从普通人群中招募。

结果

超过一半（n=605，59.0%）的受访者患有慢性疾病，主要是背痛、精神障碍、关节炎和哮喘。与没有慢性疾病的受访者相比，患有慢性疾病的受访者在确保医疗服务提供者了解他们的问题方面存在更大的困难（32.2%比 23.8%，p=0.003）、与医生进行良好的讨论（29.1%比 23.5%，p=0.05）、与医疗服务提供者讨论直到他们理解所有需要的问题（30.5%比 24.5%，p=0.04）、获得所需的医疗服务提供者（35.7%比 29.7%，p=0.05）、找到获得医疗服务的正确地点（36.3%比 29.2%，p=0.02）和他们有权获得的服务（48.3%比 40.6%，p=0.02），并为自己确定最佳的医疗保健（34.2%比 27.7%，p=0.03）。患有慢性疾病的参与者在参与和沟通方面获得低分的可能性是没有慢性疾病的参与者的 1.5 倍（调整后的比值比=1.48，p=0.03，95%置信区间 1.05 至 2.08），导航（调整后的比值比=1.43，p=0.026，95%置信区间 1.043 至 1.970）子量表，在调整了年龄、性别、收入和教育程度后。