Tomlinson J, Raymond N T, Field D, Botha J L
Department of Public Health, Leicestershire Health.
Br J Gen Pract. 1995 Aug;45(397):399-403.
The shift in care from secondary to primary services is likely to place greater demands on community hospitals. Before changes in the provision of community hospitals can occur, baseline data are needed, outlining their current use.
A study was undertaken to obtain baseline data describing the use of general practitioner beds in Leicestershire community hospitals.
A three-month prospective, observational study was carried out between February and May 1992 using data from a questionnaire completed by nurses and general practitioners and from patient hospital records. Study patients comprised all patients admitted to general practitioner beds in all eight Leicestershire community hospitals.
A 100% questionnaire response rate was obtained giving data on 685 hospital admissions. Around 70% of admissions were of patients aged 75 years and over. Of admissions, 35% were for acute care, 31% for respite care, 22% for rehabilitation, 7% for terminal/palliative care and 5% for other reasons. Fifteen per cent of patients had been transferred from a consultant bed. Of those not transferred, 91% were admitted by their usual general practitioner or practice partner and for 96% of these patients this was the general practitioner's first choice for care. There was significant variation in both the age mix and care category mix of patients between individual hospitals. Medical deterioration in an underlying condition and family pressure on the general practitioner or carers' inability to cope each contributed to around half of all admissions. Of all admissions, 38% lived alone, and 18% of carers were disabled. Incontinence was reported for 35% of patients, and 26% of all patients were of a high nursing dependency. There was low utilization of community services before admission and 33% received none. There was variation between individual hospitals in use of local and district general hospital investigations, specialist referral and types of therapy. Of 685 admissions 11% died during their stay. Of those discharged, 76% went to their own or a relative's home, 10% to a residential or nursing home and 9% were transferred to an acute bed. Nine percent of discharges were postponed and 10% were brought forward. On discharge to non-residential care, 26% of patients received no community services.
Shifting resources from secondary to primary care is a priority for purchasers. Both the introduction of the National Health Service and community care act 1990, and acute units having increasing incentives for earlier discharge, are likely to place greater demands on community hospital beds. Not all general practitioners have the option of community hospital beds. Before access to general practitioner beds can be broadened, existing beds should be used appropriately and shown to be cost-effective. Purchasers therefore require criteria for the appropriateness of admissions to general practitioner beds, and the results of a general practitioner bed cost-benefit analysis.
医疗服务从二级服务向初级服务的转变可能会给社区医院带来更大的需求。在社区医院的供应发生变化之前，需要基线数据来概述其当前的使用情况。
进行一项研究以获取描述莱斯特郡社区医院全科医生病床使用情况的基线数据。
1992年2月至5月间进行了一项为期三个月的前瞻性观察研究，使用护士和全科医生填写的问卷数据以及患者医院记录。研究患者包括莱斯特郡所有八家社区医院中入住全科医生病床的所有患者。
问卷回复率达到100%，提供了685例住院的数据。约70%的入院患者年龄在75岁及以上。入院患者中，35%为急性护理，31%为临时护理，22%为康复护理，7%为终末期/姑息护理，5%为其他原因。15%的患者是从专科医生病床转来的。在未转来的患者中，91%由其通常的全科医生或执业伙伴收治，其中96%的患者这是全科医生的首选护理方式。各医院之间患者的年龄构成和护理类别构成存在显著差异。基础疾病的病情恶化以及家庭对全科医生的压力或护理人员无法应对，各占所有入院原因的约一半。所有入院患者中，38%独自生活，18%的护理人员有残疾。35%的患者报告有失禁情况，26%的所有患者护理依赖程度高。入院前社区服务利用率低，33%的患者未接受任何社区服务。各医院在使用当地和地区综合医院检查、专科转诊及治疗类型方面存在差异。685例入院患者中有11%在住院期间死亡。出院的患者中，76%回到自己或亲属家中，10%去了养老院或护理院，9%被转到急性病床。9%的出院被推迟，10%的出院被提前。出院后进入非住院护理的患者中，26%未接受社区服务。
将资源从二级医疗转向初级医疗是采购方的优先事项。1990年《国民健康服务和社区护理法案》的出台以及急性病单元对提前出院的激励措施增加，都可能给社区医院病床带来更大需求。并非所有全科医生都能选择社区医院病床。在扩大使用全科医生病床之前，应适当使用现有病床并证明其具有成本效益。因此，采购方需要确定全科医生病床入院适宜性的标准以及全科医生病床成本效益分析的结果。
