Department of Primary Care and Public Health, School of Public Health, Imperial College London, London W6 8RP, UK.
J R Soc Med. 2024 Jan;117(1):24-35. doi: 10.1177/01410768231186224. Epub 2023 Jul 14.
To summarise the impact of community-based interventions for multimorbid patients on unplanned healthcare use. The prevalence of multimorbidity (co-existence of multiple chronic conditions) is rapidly increasing and affects one-third of the global population. Patients with multimorbidity have complex healthcare needs and greater unplanned healthcare usage. Community-based interventions allow for continued care of patients outside hospitals, but few studies have explored the effects of these interventions on unplanned healthcare usage.
A systematic review was conducted. MEDLINE, EMBASE, PsychINFO and Cochrane Library online databases were searched. Studies were screened and underwent risk of bias assessment. Data were synthesised using narrative synthesis.
Community-based interventions.
Patients with multimorbidity.
Unplanned healthcare usage.
Thirteen studies, including a total of 6148 participants, were included. All included studies came from high-income settings and had elderly populations. All studies measured emergency department attendances as their primary outcome. Risk of bias was generally low. Most community interventions were multifaceted with emphasis on education, self-monitoring of symptoms and regular follow-ups. Four studies looked at improved care coordination, advance care planning and palliative care. All 13 studies found a decrease in emergency department visits post-intervention with risk reduction ranging from 0 (95% confidencec interval [CI]: -0.37 to 0.37) to 0.735 (95% CI: 0.688-0.785).
Community-based interventions have potential to reduce emergency department visits in patients with multimorbidity. Identification of specific successful components of interventions was challenging given the overlaps between interventions. Policymakers should recognise the importance of community interventions and aim to integrate aspects of these into existing healthcare structures. Future research should investigate the impact of such interventions with broader participant characteristics.
总结针对多病种患者的基于社区的干预措施对非计划性医疗保健使用的影响。多病种（多种慢性疾病同时存在）的患病率正在迅速上升，影响了全球三分之一的人口。患有多病种的患者有复杂的医疗保健需求，并且非计划性医疗保健使用的频率更高。基于社区的干预措施可以在医院外继续为患者提供护理，但很少有研究探讨这些干预措施对非计划性医疗保健使用的影响。
系统评价。检索了 MEDLINE、EMBASE、PsychINFO 和 Cochrane Library 在线数据库。对研究进行了筛选和偏倚风险评估。使用叙述性综合法对数据进行了综合。
基于社区的干预措施。
患有多病种的患者。
非计划性医疗保健使用。
纳入了 13 项研究，共纳入 6148 名参与者。所有纳入的研究均来自高收入环境，且研究人群均为老年人。所有研究均将急诊就诊作为其主要结局进行测量。偏倚风险通常较低。大多数社区干预措施具有多方面的特点，重点是教育、症状自我监测和定期随访。有 4 项研究关注改善医疗协调、预先护理计划和姑息治疗。所有 13 项研究均发现干预后急诊就诊次数减少，风险降低范围为 0（95%置信区间：-0.37 至 0.37）至 0.735（95%置信区间：0.688 至 0.785）。
基于社区的干预措施有可能减少多病种患者的急诊就诊次数。由于干预措施之间存在重叠，因此确定干预措施的具体成功因素具有挑战性。决策者应认识到社区干预措施的重要性，并努力将这些措施纳入现有医疗保健结构中。未来的研究应调查此类干预措施对具有更广泛参与者特征的影响。
