Comparing and improving chronic illness primary care in Sweden and the USA.
Comparing and improving chronic illness primary care in Sweden and the USA.
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比较和改善瑞典和美国的慢性病初级保健。
DOI：
10.1108/ijhcqa-02-2016-0014
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发表时间：
2016
影响因子：
1.5
通讯作者：
M. Brommels
中科院分区：
文献类型：
--
作者：
J. Øvretveit;P. Ramsay;S. Shortell;M. Brommels
本文的目的是通过比较瑞典和美国的服务如何使用循证实践（EBP），包括数字健康技术（DHT），来确定改善慢性病患者初级保健服务的机会。设计/方法/方式-一个国家的初级卫生保健中心（PHCC）负责人在2012-2013年在这两个国家在2006年进行的调查。结果-两国之间有很大的差异。最大的，关于在初级保健中心有效使用双氢睾酮，是很少有瑞典初级保健相比，美国负责人报告有提醒或提示在护理点（38%瑞典对84%美国），尽管瑞典建立了电子病历（EMR）。瑞典负责人还报告说，接收实验室结果的中心减少了30%（瑞典为67%，美国为97%）。关于遵循其他EBP，70%的瑞典中心负责人报告说，他们的医生很容易获得糖尿病患者名单，而美国只有14%。大多数瑞典PHCC负责人（96%）表示，他们提供当天预约，而在美国，这一比例为36%。实际影响-有机会改善的基础上显着差异的国家之间的有效做法，这表明初级保健领导人，他们的同行在其他地方可能提供更好的照顾慢性病患者。一些改善是在初级保健中心的控制下，可以迅速作出。有证据表明，这两个国家的慢性病患者正在遭受不必要的痛苦，因为初级保健工作人员未能提供经证明的EBP，这将更好地满足患者的需求。公共财政已投资于人口贩运，但没有充分发挥其潜力。独创性/价值-这项研究表明，目前和潜在的证明有效的EBP慢性病患者的服务之间的差距。研究结果表明，通过比较两国的差异和实际改进可能的解释。许多增强是低成本的，而它们带来的痛苦和成本的比例减少是很高的。
Purpose - The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach - A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings - There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden's established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications - There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value - The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.