日本接受居家医疗护理患者的以患者为中心的护理、生活质量与希望：一项多中心横断面研究。

Patient-centred care and quality of life and hope among Japanese patients receiving home medical care: a multicentre, cross-sectional study.

作者信息

Iida Hidekazu, Hayashi Shinu, Yasunaka Masakazu, Tsugihashi Yukio, Hirose Misaki, Shirahige Yutaka, Kurita Noriaki

机构信息

Center for Next Generation of Community Health, Chiba University Hospital, Chiba-city, Chiba, Japan.

Department of Clinical Epidemiology, Graduate School of Medicine, Fukushima Medical University, Fukushima-city, Fukushima, Japan.

出版信息

BMJ Open. 2025 Jan 6;15(1):e089639. doi: 10.1136/bmjopen-2024-089639.

DOI:10.1136/bmjopen-2024-089639

PMID:39762091

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11749788/

Abstract

OBJECTIVES

Patient-reported outcomes reflecting quality of life (QOL) and hope are essential targets for in-home medical care. This study examined the association between the quality of patient-centred care and both QOL and hope.

DESIGN

Multicentre, cross-sectional study.

SETTING

Twenty-nine home care clinics in the Tokyo Metropolitan Area, Nara Prefecture and Nagasaki Prefecture in Japan.

PARTICIPANTS

200 patients receiving home medical care.

EXPOSURE

Patient-centredness was measured using the Japanese version of the Primary Care Assessment Tool-Short Form (JPCAT-SF).

OUTCOME MEASURES

The primary outcome measures were QOL, assessed using the QOL-Home Care (QOL-HC) scale, and hope, measured using the Health-Related Hope (HR-Hope) scale. Mixed-effects linear models were applied.

RESULTS

A higher JPCAT-SF total score was associated with a higher QOL-HC score (adjusted mean difference per 10-point increase: 0.28, 95% CI 0.16 to 0.40). Among the JPCAT-SF domains, higher scores in first contact (0.16, 95% CI 0.08 to 0.23), longitudinality (0.20, 95% CI 0.11 to 0.29), comprehensiveness (services available) (0.12, 95% CI 0.03 to 0.20), comprehensiveness (services provided) (0.08, 95% CI 0.01 to 0.15) and community orientation (0.11, 95% CI 0.02 to 0.20) were also associated with higher QOL-HC scores. Similarly, a higher JPCAT-SF total score was associated with a higher HR-Hope score (adjusted mean difference per 10-point increase: 4.8, 95% CI 2.9 to 6.7). Additionally, higher scores in individual JPCAT-SF domains were associated with higher HR-Hope scores: first contact (2.7, 95% CI 1.3 to 4.1), longitudinality (2.5, 95% CI 0.8 to 4.2), coordination (1.2, 95% CI 0.2 to 2.3), comprehensiveness (services available: 1.8, 95% CI 0.5 to 3.2; services provided: 1.3, 95% CI 0.4 to 2.3) and community orientation (1.8, 95% CI 0.5 to 3.1).

CONCLUSIONS

Higher quality patient-centred care is positively associated with enhanced QOL and hope among home medical care patients. Patient-centredness should be strengthened in daily clinical practice.

摘要

目的

反映生活质量（QOL）和希望的患者报告结局是居家医疗护理的重要目标。本研究探讨了以患者为中心的护理质量与生活质量和希望之间的关联。

设计

多中心横断面研究。

地点

日本东京都、奈良县和长崎县的29家家庭护理诊所。

参与者

200名接受居家医疗护理的患者。

暴露因素

使用初级保健评估工具简表（JPCAT-SF）的日语版来衡量以患者为中心的程度。

结局指标

主要结局指标为生活质量，采用居家护理生活质量（QOL-HC）量表进行评估；希望，采用健康相关希望（HR-Hope）量表进行测量。应用混合效应线性模型。

结果

JPCAT-SF总分越高，QOL-HC得分越高（每增加10分的调整后平均差异：0.28，95%可信区间0.16至0.40）。在JPCAT-SF的各个领域中，首次接触得分较高（0.16，95%可信区间0.08至0.23）、连续性得分较高（0.20，95%可信区间0.11至0.29）、全面性（可用服务）得分较高（0.12，95%可信区间0.03至0.20）、全面性（提供的服务）得分较高（0.08，95%可信区间0.01至0.15）以及社区导向得分较高（0.11，95%可信区间0.02至0.20）也与较高的QOL-HC得分相关。同样，JPCAT-SF总分越高，HR-Hope得分越高（每增加10分的调整后平均差异：4.8，95%可信区间2.9至6.7）。此外，JPCAT-SF各个领域得分较高与较高的HR-Hope得分相关：首次接触（2.7，95%可信区间1.3至4.1）、连续性（2.5，95%可信区间0.8至4.2）、协调性（1.2，95%可信区间0.2至2.3）、全面性（可用服务：1.8，95%可信区间0.5至3.2；提供的服务：1.3，95%可信区间0.4至2.3）以及社区导向（1.8，95%可信区间0.5至3.1）。