澳大利亚长期护理入院前后的基层医疗服务利用情况。

Primary health care service utilisation before and after entry into long-term care in Australia.

机构信息

The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia; Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.

The Registry of Senior Australians (ROSA), South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Flinders Health and Medical Research Institute, Division of Rehabilitation, Aged and Palliative Care, Flinders Drive, Bedford Park, SA, Australia.

出版信息

Arch Gerontol Geriatr. 2024 Feb;117:105210. doi: 10.1016/j.archger.2023.105210. Epub 2023 Sep 24.

DOI:10.1016/j.archger.2023.105210

PMID:37812974

Abstract

OBJECTIVES

To examine utilisation of primary health care services (subsidised by the Australian Government, Medicare Benefits Schedule, MBS) before and after entry into long-term care (LTC) in Australia.

METHODS

A retrospective cohort study of older people (aged ≥65 years) who entered LTC in Australia between 2012 and 2016 using the Historical Cohort of the Registry of Senior Australians. MBS-subsidised general attendances (general practitioner (GP), medical and nurse practitioners), health assessment and management plans, allied health, mental health services and selected specialist attendances accessed in 91-day periods 12 months before and after LTC entry were examined. Adjusted relative changes in utilisation 0-3 months before and after LTC entry were estimated using risk ratios (RR) calculated using Generalised Estimating Equation Poisson models.

RESULTS

235,217 residents were included in the study with a median age of 84 years (interquartile range 79-89) and 61.1% female. In the first 3 months following LTC entry, GP / medical practitioner attendances increased from 86.6% to 95.6% (aRR 1.10 95%CI 1.10-1.11), GP / medical practitioner urgent after hours (from 12.3% to 21.1%; aRR 1.72, 95%CI 1.70-1.74) and after-hours attendances (from 18.5% to 33.8%; aRR 1.83, 95%CI 1.81-1.84) increased almost two-fold. Pain, palliative and geriatric specialist medicine attendances were low in the 3 months prior (<3%) and decreased further following LTC admission.

CONCLUSION

There is an opportunity to improve the utilisation of primary health care services following LTC entry to ensure that residents' increasingly complex care needs are adequately met.

摘要

目的

研究澳大利亚老年人进入长期护理（LTC）前后初级保健服务（由澳大利亚政府补贴，医疗保险福利计划，MBS）的利用情况。

方法

本研究采用澳大利亚老年人登记处历史队列中年龄≥65 岁的老年人（2012 年至 2016 年期间进入 LTC）的回顾性队列研究。在 LTC 进入前 12 个月和后 91 天内，检查了 MBS 补贴的一般就诊（全科医生（GP）、医生和护士从业者）、健康评估和管理计划、联合健康、心理健康服务和选定的专科就诊情况。使用广义估计方程泊松模型计算的风险比（RR）估计 LTC 进入前后 0-3 个月利用情况的调整相对变化。

结果

本研究共纳入 235217 名居民，中位年龄为 84 岁（四分位距 79-89），61.1%为女性。在进入 LTC 后的前 3 个月内，GP/医疗从业者就诊率从 86.6%增加到 95.6%（aRR 1.10，95%CI 1.10-1.11），GP/医疗从业者紧急下班后就诊率从 12.3%增加到 21.1%（aRR 1.72，95%CI 1.70-1.74）和下班后就诊率从 18.5%增加到 33.8%（aRR 1.83，95%CI 1.81-1.84）增加了近两倍。疼痛、姑息和老年医学专科就诊率在 3 个月前较低（<3%），在进入 LTC 后进一步下降。