A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.
A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care.
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DOI：
10.1186/1472-6963-12-415
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发表时间：
2012-11-21
影响因子：
2.8
通讯作者：
Harris MF
中科院分区：
文献类型：
--
作者：
Comino EJ;Davies GP;Krastev Y;Haas M;Christl B;Furler J;Raymont A;Harris MF
虽然初级保健是所有保健系统的一个关键组成部分，但服务并不总是随时可用、可获得或负担得起。本系统性综述探讨了有效的战略，以提高获得最佳实践过程中的PHC在三个领域：慢性病管理，预防和偶发性护理。对书目数据库进行了广泛检索，以识别同行和非同行评审文献。对确定的论文进行筛选，以确定和分类干预研究，这些研究衡量了战略（单独或组合）对特定人群中服务使用或覆盖范围变化的影响（评估干预措施）。检索确定了3，148篇引文，其中121篇为干预研究，75篇为评估干预措施。评估干预措施发现在所有三个领域：预防（n = 45），偶发性护理（n = 19），慢性病管理（n = 11）。这些研究在许多国家进行，包括澳大利亚（n = 25）、美国（n = 25）和英国（n = 15）。研究质量分为高（31%的研究）、中（61%）和低（8%）。评价的75项干预措施测试了一系列策略，无论是单独的（n = 46项研究）还是两种（n = 20）或多种策略（n = 9）的组合。策略针对医疗服务提供者和患者，并分为五组：实践重组（n = 43项研究），患者支持（n = 29），提供新的服务（n = 19），劳动力发展（n = 11）和财政激励（n = 9）。战略因领域而异，反映了护理需求和过程的复杂性。在75项评价的干预措施中，55项报告了积极的结果，而采用综合战略的干预措施更有可能报告积极的结果。这项审查表明，针对不同层次的卫生保健系统的多重，相互关联的战略是最有可能改善获得最佳做法的初级保健。澳大利亚初级保健结构的拟议变化可能提供机会，以调查影响获得最佳做法初级保健的因素，并制定和实施有效的、以证据为基础的战略来解决这些问题。
Although primary health care (PHC) is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination) on change in use or the reach of services in defined population groups (evaluated interventions). The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n = 45), episodic care (n = 19), and chronic disease management (n = 11). They were undertaken in a number of countries including Australia (n = 25), USA (n = 25), and UK (n = 15). Study quality was ranked as high (31% of studies), medium (61%) and low (8%). The 75 evaluated interventions tested a range of strategies either singly (n = 46 studies) or as a combination of two (n = 20) or more strategies (n = 9). Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n = 43 studies), patient support (n = 29), provision of new services (n = 19), workforce development (n = 11), and financial incentives (n = 9). Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. This review suggests that multiple, linked strategies targeting different levels of the health care system are most likely to improve access to best practice PHC. The proposed changes in the structure of PHC in Australia may provide opportunities to investigate the factors that influence access to best practice PHC and to develop and implement effective, evidence based strategies to address these.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
Nathan, DM
影响因子：
2.8
作者：
O'Cathain, Alicia;Knowles, Emma;Nicholl, Jon
通讯作者：
Nicholl, Jon
影响因子：
2.1
作者：
Grewal, S;Bottorff, JL;Balneaves, LG
通讯作者：
Balneaves, LG
影响因子：
11.4
作者：
Bailie, RS;Si, D;d'Abbs, PHN
通讯作者：
d'Abbs, PHN
影响因子：
2.4
作者：
Gulliford, Martin;Figueroa-Munoz, Jose;Hudson, Meryl
通讯作者：
Hudson, Meryl