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负责全面照料患有多种疾病的老年患者的全科医生和老年病医生的特点。

The characteristics of general practitioners and geriatricians who take overall responsibility for the care of older patients with multimorbidity.

作者信息

Kimura Takuma, Matsumura Shinji, Hashimoto Masayoshi, Shinmura Ken

机构信息

Department of R&D Innovation for Home Care Medicine Tokyo Medical and Dental University School of Medicine Tokyo Japan.

Department of General Medicine Tokyo Medical and Dental University School of Medicine Tokyo Japan.

出版信息

J Gen Fam Med. 2024 Sep 18;25(6):366-375. doi: 10.1002/jgf2.727. eCollection 2024 Nov.

Abstract

BACKGROUND

Older patients with multimorbidity often seek care from multiple health care providers and visit several medical institutions. Having a primary care provider who takes overall responsibility for their care may be beneficial. We conducted a survey to identify the characteristics of general practitioners and geriatricians who frequently assume such responsibility for older patients with multimorbidity.

METHODS

In June 2022, we distributed by mail an anonymous questionnaire to 3300 family medicine specialists, primary care-certified physicians, and geriatric specialists in Japan. We used a four-point Likert-type scale to score items related to conditions and patient backgrounds that pose challenges in treatment, key clinical factors, and important clinical strategies. Modified Poisson regression was used to identify factors associated with frequently assuming overall responsibility for medical care.

RESULTS

Data from 746 physicians were included in the analysis. Factors associated with frequently assuming overall responsibility for medical care of older patients with multimorbidity included providing inpatient ward care (prevalence ratio [PR] 1.237, 95% CI 1.124-1.362), providing home medical care (PR 1.357, 95% CI 1.225-1.504), frequently treating patients over 90 years old (PR 2.043, 95% CI 1.258-3.318), and the overall score for clinical strategies (PR 1.021, 95% CI 1.010-1.033).

CONCLUSIONS

General practitioners and geriatricians who frequently assume overall responsibility for the care of older patients with multimorbidity tend to engage significantly in ward and home medical care, often treat patients above 90 years, and employ numerous clinical strategies.

摘要

背景

患有多种疾病的老年患者经常向多个医疗服务提供者寻求治疗,并前往多家医疗机构就诊。拥有一位对其治疗承担全面责任的初级保健提供者可能会有所帮助。我们进行了一项调查,以确定经常为患有多种疾病的老年患者承担此类责任的全科医生和老年病医生的特征。

方法

2022年6月,我们通过邮件向日本的3300名家庭医学专家、初级保健认证医生和老年病专家发放了一份匿名问卷。我们使用四点李克特量表对与治疗中存在挑战的病情和患者背景、关键临床因素以及重要临床策略相关的项目进行评分。采用修正泊松回归分析来确定与经常承担医疗护理全面责任相关的因素。

结果

746名医生的数据纳入分析。与经常为患有多种疾病的老年患者承担医疗护理全面责任相关的因素包括提供住院病房护理(患病率比[PR]1.237, 95%可信区间1.124 - 1.362)、提供家庭医疗护理(PR 1.357, 95%可信区间1.225 - 1.504)、经常治疗90岁以上患者(PR 2.043, 95%可信区间1.258 - 3.318)以及临床策略的总体评分(PR 1.021, 95%可信区间1.010 - 1.033)。

结论

经常为患有多种疾病的老年患者承担全面护理责任的全科医生和老年病医生往往大量参与病房和家庭医疗护理,经常治疗90岁以上患者,并采用多种临床策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/3948/11565074/3292490e6a36/JGF2-25-366-g001.jpg

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