Faculty of Medicine, University Vita-Salute San Raffaele, Milan, Italy.
Epidemiology of Cancer Healthcare & Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, Institute of Epidemiology & Health Care, University College London, London UK.
Ann Ig. 2024 Mar-Apr;36(2):227-233. doi: 10.7416/ai.2024.2608. Epub 2024 Jan 31.
Primary healthcare plays a central role in providing preventive care, managing chronic conditions and reducing inappropriate emergency presentations. The study aimed at providing population-level evidence on the correlation between the characteristics of primary healthcare across Italian regions and health outcomes included in the National Programs Outcomes of the National Agency for Regional Healthcare Services.
Ecological study.
We analysed healthcare data from the National Agency for Regional Healthcare Services, the public lists of primary care doctors and the National Federation of Surgeons and Dentists and the National Institutes of Statistics referring to the 20 Italian regions. Pearson's correlation and Spearman's correlation were used to assess the relationships between primary healthcare characteristics and health outcomes.
Overall, across all Italian regions each general practitioner had on average 1447 patients and was 57.5 years old. The study found positive correlations between the number of patients per general practitioner and non-urgent Emergency Department visits among adult patients (Pearson's r = 0.58, p = 0.008), the number of residents aged 65+ per general practitioner and the rate of chronic obstructive pulmonary disease admissions (Pearson's r = 0.49, p = 0.029), and the age of general practitioners and lower-extremity amputations in diabetes patients (Pearson's r = 0.56, p = 0.011). A negative correlation was observed between the age of general practitioners and urinary tract infection admissions (Pearson's r = -0.76; p < 0.001). A non-linear negative correlation was found between the age of general practitioners and chronic obstructive pulmonary disease admissions (Spearman's ρ = -0.46, p = 0.041).
The findings emphasise the importance of guaranteeing sufficient numbers of primary healthcare physicians to meet patients' needs, and for limiting avoidable hospitalisations and emergency presentations. General practitioners' age might also influence the provision of care, but more research is needed on possible mechanisms.
初级医疗保健在提供预防保健、管理慢性病和减少不必要的紧急就诊方面发挥着核心作用。本研究旨在提供人群层面的证据，说明意大利各地区初级医疗保健的特征与国家区域医疗保健服务机构国家计划成果中包含的健康结果之间的相关性。
生态研究。
我们分析了来自国家区域医疗保健服务机构、初级保健医生的公共名单以及国家外科医生和牙医联合会和国家统计研究所的医疗保健数据，涉及意大利的 20 个地区。使用 Pearson 相关系数和 Spearman 相关系数评估初级保健特征与健康结果之间的关系。
总体而言，意大利所有地区的每位全科医生平均有 1447 名患者，年龄为 57.5 岁。研究发现，每位全科医生的患者人数与成年患者非紧急急诊就诊次数之间存在正相关（Pearson's r = 0.58，p = 0.008），每位全科医生的 65 岁以上居民人数与慢性阻塞性肺病入院率之间存在正相关（Pearson's r = 0.49，p = 0.029），以及全科医生的年龄与糖尿病患者下肢截肢之间存在正相关（Pearson's r = 0.56，p = 0.011）。还观察到全科医生的年龄与尿路感染入院率之间存在负相关（Pearson's r = -0.76；p < 0.001）。全科医生的年龄与慢性阻塞性肺病入院率之间存在非线性负相关（Spearman's ρ = -0.46，p = 0.041）。
研究结果强调了保证有足够数量的初级医疗保健医生来满足患者需求的重要性，并限制了不必要的住院和急诊就诊。全科医生的年龄也可能影响医疗服务的提供，但需要进一步研究可能的机制。
