Department of Healthcare Administration and Medical Informatics, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City, Taiwan.
Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan.
Front Public Health. 2023 May 9;11:1147732. doi: 10.3389/fpubh.2023.1147732. eCollection 2023.
Hospitalizations or emergency department (ED) visits due to ambulatory care-sensitive conditions (ACSC) are preventable but cost billions in modern countries. The objective of the study is to use a meta-synthesis approach based on patients' narratives from qualitative studies to reveal why individuals are at risk of ACSC hospitalizations or ED visits.
PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to identify qualified qualitative studies. The Preferred Reporting Items for Systematic Review and Meta-Analysis were used for reporting the review. The thematic synthesis was used to analyze the data.
Among 324 qualified studies, nine qualitative studies comprising 167 unique individual patients were selected based on the inclusion/exclusion criteria. Through the meta-synthesis, we identified the core theme, four major themes, and the corresponding subthemes. Poor disease management, the core theme, turns individuals at risk of ACSC hospitalizations or ED visits. The four major themes contribute to poor disease management, including difficulties in approaching health services, non-compliance with medications, difficulties in managing the disease at home, and poor relationships with providers. Each major theme comprised 2-4 subthemes. The most cited subthemes are relative to upstream social determinants, such as financial constraints, inaccessible health care, low health literacy, psychosocial or cognitive constraints.
Without addressing upstream social determinants, socially vulnerable patients are unlikely to manage their disease well at home even though they know how to do it and are willing to do it.
National Library of Medicine, with ClinicalTrials.gov, Identifier: NCT05456906. https://clinicaltrials.gov/ct2/show/NCT05456906.
在现代国家，由于可预防的门诊医疗敏感条件（ACSC）而导致的住院或急诊就诊会耗费数十亿美元。本研究的目的是使用基于定性研究中患者叙述的元综合方法来揭示为什么个体存在 ACSC 住院或急诊就诊的风险。
利用 PubMed、Embase、Cochrane 图书馆和 Web of Science 数据库来确定合格的定性研究。采用系统评价和荟萃分析的首选报告项目来报告综述。采用主题综合分析来分析数据。
在 324 项合格研究中，根据纳入/排除标准，选择了九项定性研究，其中包括 167 名独特的个体患者。通过元综合，我们确定了核心主题、四个主要主题和相应的子主题。较差的疾病管理是个体存在 ACSC 住院或急诊就诊风险的核心主题。四个主要主题有助于较差的疾病管理，包括难以接近卫生服务、不遵守药物治疗、在家中管理疾病困难以及与提供者的关系不佳。每个主要主题包含 2-4 个子主题。引用最多的子主题与上游社会决定因素有关，如经济限制、医疗保健不可及、健康素养低、心理社会或认知限制。
如果不解决上游社会决定因素，即使患者知道如何做并且愿意做，他们也不太可能在家中很好地管理自己的疾病，因为他们处于社会弱势地位。
美国国立医学图书馆，ClinicalTrials.gov 标识符：NCT05456906。https://clinicaltrials.gov/ct2/show/NCT05456906。
