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在单因素预测分析中,指定的全科医生(GP)与住院天数的增加有关:随访时间为 15 年。

A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years.

机构信息

Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.

The Wellbeing Services County of Pirkanmaa, Tampere, Finland.

出版信息

BMC Health Serv Res. 2023 Oct 28;23(1):1178. doi: 10.1186/s12913-023-10184-5.

Abstract

BACKGROUND

Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system.

OBJECTIVES

The aim of the study was to determine whether having a named GP is associated with hospital service use.

METHODS

The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register).

RESULTS

A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis.

CONCLUSION

A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized.

摘要

背景

医疗连续性是基层医疗服务的基础,与住院率降低有关。在芬兰,基层医疗的可及性和医院服务利用率的增加被认为是医疗体系面临的挑战。

目的

本研究旨在确定是否有指定的全科医生与医院服务的使用有关。

方法

该数据是基于芬兰随机工作年龄人群样本的健康和社会支持研究(HeSSup)的一部分。研究队列包括 1998 年邮寄调查的参与者(n=25898),他们在 2003 年和 2012 年都回复了随访问卷(n=11924)。问卷调查中询问了背景特征,住院情况则从国家登记处(Hilmo-register)获取。

结果

只有 34.3%的参与者在 2003 年和 2012 年均报告了有指定的全科医生。在单因素预测模型中,与住院天数相关的与有指定的全科医生的线性关系具有统计学意义。与医院使用最密切相关的是与健康相关的因素,而在多分类分析中与指定的全科医生的关联不再显著。

结论

有指定的全科医生与住院天数的增加有关,但在多分类分析中这种关联消失了。健康相关因素与住院天数的关联最强。从正在进行的芬兰卫生和社会服务改革的角度来看,应强调医疗连续性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2b22/10613364/a05797a4950a/12913_2023_10184_Fig1_HTML.jpg

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