国际初级保健实践和医生与预先医疗指示相关的特征：一项横断面调查研究。

Characteristics of international primary care practices and physicians related to advance care planning: a cross-sectional survey study.

机构信息

Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA.

Institute for Health, Health Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.

出版信息

BMC Prim Care. 2023 Jul 14;24(1):146. doi: 10.1186/s12875-023-02103-8.

DOI:10.1186/s12875-023-02103-8

PMID:37452276

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10347754/

Abstract

BACKGROUND

Primary care providers (PCPs) are well-situated to delivery primary palliative care such as advance care planning (ACP). The aim of this work is to identify practice characteristics, including features found in advanced primary care models (APCMs), that predict PCP engagement of patients in ACP.

METHODS

We analyzed characteristics of physician respondents and their practices associated with ACP conversations in older and sicker patients using data from 11 countries who participated in the 2015 Commonwealth Fund International Survey of Primary Care Physicians in 10 Nations. The primary outcome was how routinely these ACP conversations are reported. We used a validated measure to describe practice-level characteristics of advanced primary care models. We conducted bivariate and multivariable analyses to determine PCP and practice characteristics associated with routinely engaging patients in ACP and with documenting patient preferences in medical records.

RESULTS

Respondents (N = 12,049) predominantly were older than 45 and did not view their jobs as high stress. PCPs reported routinely engaging patients in ACP work in practices with more APCM features. They are more likely to view their jobs as high stress, to work more hours, to practice in rural areas, and to work in smaller practices. Multivariable analyses showed that older PCP age, higher perceived stress of the job, practice location in rural areas, and increased number of APCM features were associated with more ACP conversations. Increased number of APCM features was also associated with higher odds of routinely recording patient preferences in their medical records.

CONCLUSIONS

In this international survey, physician and practice characteristics, including having features associated with APCMs, were associated with whether physicians routinely discuss ACP with patients who are older and sicker. Many features of APCMs may facilitate ACP discussions between PCPs and patients.

摘要

背景

初级保健提供者（PCP）非常适合提供初级姑息治疗，如预先护理计划（ACP）。这项工作的目的是确定实践特征，包括在高级初级保健模式（APCM）中发现的特征，这些特征可以预测 PCP 与患者进行 ACP 的接触。

方法

我们使用来自 11 个国家的 2015 年英联邦基金会国际初级保健医师调查的数据，分析了参与该调查的医师受访者及其实践与老年和病患者 ACP 对话相关的特征。主要结果是报告这些 ACP 对话的常规性。我们使用经过验证的方法来描述高级初级保健模式的实践水平特征。我们进行了单变量和多变量分析，以确定与常规参与患者 ACP 以及在医疗记录中记录患者偏好相关的 PCP 和实践特征。

结果

受访者（N=12049）主要年龄在 45 岁以上，不认为他们的工作压力很大。PCP 在具有更多 APCM 特征的实践中报告常规参与患者的 ACP 工作。他们更有可能认为自己的工作压力大，工作时间长，在农村地区工作，在规模较小的实践中工作。多变量分析表明，PCP 年龄较大、工作压力较大、实践地点在农村地区以及 APCM 特征数量增加与更多 ACP 对话相关。更多的 APCM 特征也与更高的可能性记录患者在医疗记录中的偏好相关。