Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
Department of Health Sciences, University of Florence, Florence, Italy.
Int Nurs Rev. 2024 Dec;71(4):716-728. doi: 10.1111/inr.13033. Epub 2024 Jul 29.
To meet the population's needs, community care should be customized and continuous, adequately equipped, and monitored.
Considering their fragmented and heterogeneous nature, a summary of community healthcare services described in European literature is needed. The aim of this study was to summarize their organizational models, outcomes, nursing contribution to care, and nursing-related determinants of outcomes.
A systematic review was performed by searching PubMed, CINAHL, Scopus, and Embase in October 2022 and October 2023 (for updated results). Quantitative studies investigating the effects of community care, including nursing contribution, on patient outcomes were included and summarized. Reporting followed the PRISMA checklist. The review protocol was registered on PROSPERO (CRD42022383856).
Twenty-three studies describing six types of community care services were included, which are heterogeneous in terms of target population, country, interventions, organizational characteristics, and investigated outcomes. Heterogeneous services' effects were observed for access to emergency services, satisfaction, and compliance with treatment. Services revealed a potential to reduce rehospitalizations of people with long-term conditions, frail or older persons, children, and heart failure patients. Models are mainly multidisciplinary and, although staffing and workload may also have an impact on provided care, this was not enough investigated.
Community health services described in European literature in the last decade are in line with population needs and suggest different suitable models and settings according to different care needs. Community care should be strengthened in health systems, although the influence of staffing, workload, and work environment on nursing care should be investigated by developing new management models.
Community care models are heterogeneous across Europe, and the optimum organizational structure is not clear yet. Future policies should consider the impact of community care on both health and economic outcomes and enhance nursing contributions to care.
为满足人口需求，社区护理应具有针对性且持续不断，设备充足并受到监测。
鉴于社区医疗保健服务具有分散性和异质性，有必要对欧洲文献中描述的社区医疗保健服务进行总结。本研究旨在总结其组织模式、结果、护理对护理的贡献以及与护理相关的结果决定因素。
2022 年 10 月和 2023 年 10 月，通过检索 PubMed、CINAHL、Scopus 和 Embase 进行了系统评价（检索结果更新）。纳入并总结了调查社区护理（包括护理贡献）对患者结局影响的定量研究。报告遵循 PRISMA 清单。审查方案在 PROSPERO（CRD42022383856）上注册。
纳入了 23 项描述六种类型社区护理服务的研究，这些服务在目标人群、国家、干预措施、组织特征和调查结果方面存在异质性。不同服务的效果在获得急诊服务、满意度和治疗依从性方面存在差异。这些服务显示出降低患有慢性病、身体虚弱或老年人、儿童和心力衰竭患者再次住院的潜力。这些模式主要是多学科的，尽管人员配备和工作量也可能对提供的护理产生影响，但这一点尚未得到充分研究。
过去十年中，欧洲文献中描述的社区卫生服务符合人口需求，并根据不同的护理需求提出了不同的合适模式和设置。尽管需要通过开发新的管理模式来研究人员配备、工作量和工作环境对护理的影响，但应加强卫生系统中的社区护理。
全欧各地的社区护理模式存在差异，最佳组织结构尚不清楚。未来的政策应考虑社区护理对健康和经济结果的影响，并加强护理对护理的贡献。
