Care of patients with selected health problems in fundholding practices in Scotland in 1990 and 1992: needs, process and outcome.
Care of patients with selected health problems in fundholding practices in Scotland in 1990 and 1992: needs, process and outcome.
复制标题
1990 年和 1992 年苏格兰基金持有实践中对患有特定健康问题的患者的护理：需求、过程和结果。
DOI：
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发表时间：
1995
期刊：
影响因子：
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通讯作者：
Margaret Maxwell
中科院分区：
文献类型：
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作者：
J. Howie;David Heaney;Margaret Maxwell
背景
在引入基金持有的时候，对基金持有的一些潜在好处和担忧进行了辩论。
目标
在苏格兰的六个基金组织中，进行了一项研究，以比较1990年和1992年不同身体、社会和心理需要的患者的护理过程和结果。
方法
在1990年和1992年，年龄在16岁及以上的患者咨询了一系列标志性疾病，完成了会诊前的健康状况问卷，询问了身体、社会和心理问题，以及会诊后的满意度/使用性问卷，询问了他们应对和了解自己疾病的能力。主要观察指标为会诊时长和满意度/使命性评分。
结果
在研究期间就诊的患者中，39%的患者咨询一种或多种标志性疾病。报告社会问题的患者比例在1990年至1992年期间上升，其中12种情况中有11种。总体而言，咨询时间长短保持不变。想要讨论社会问题的患者比那些报告没有社会问题或他们不想讨论的问题的患者咨询的时间要长得多。在1990至1992年间，患者表示使能的比例下降了8次，上升了4次。在控制了报告社会问题的百分比的上升后，表示支持的比例仍然下降。那些有他们不想讨论的社会问题，但一般健康问卷得分在5分或更高的患者报告的使命性最低。与1990年相比，1992年有疼痛、皮肤问题和消化问题的患者报告社会问题的人数明显增加，报告使其成为性伴侣的患者明显减少。在研究期间，患有糖尿病、心绞痛、慢性支气管炎和视力问题的患者表现相对较好。一些有心理社会问题的患者情况不佳(他们的会诊时间相对较短，不太可能表现出应对/理解自己疾病的能力)。
结论
讨论了一些患者群体从最近的医疗服务变化中获得的好处是否与其他群体的劣势相匹配的问题，例如，那些有临床问题、没有提供主动护理的经济激励或有心理社会困难的群体。
BACKGROUND
At the time of the introduction of fundholding, a number of potential benefits and concerns about fundholding were debated.
AIM
A study was undertaken to compare process and outcome of care in patients with different levels of physical, social and psychological need in 1990 and 1992 in six fundholding groups in Scotland.
METHOD
Patients aged 16 years and over consulting with a range of marker conditions in 1990 and 1992 completed a pre-consultation health status questionnaire asking about physical, social and psychological problems, and a postconsultation satisfaction/enablement questionnaire asking about their ability to cope, and understand their illness. Main outcome measures were consultation length and satisfaction/enablement score.
RESULTS
Of patients attending in the study period, 39% consulted for one or more marker condition. The proportion of patients reporting social problems rose between 1990 and 1992 for 11 out of 12 conditions. Overall, consultation lengths remained constant. Patients wanting to discuss social problems had significantly longer consultations than those reporting no social problems or problems they did not wish to discuss. The proportion of patients expressing enablement dropped for eight conditions and rose for four between 1990 and 1992. The decrease in the proportion expressing enablement remained after controlling for the rise in the percentage reporting social problems. Patients who had social problems they did not wish to discuss but a general health questionnaire score of five or more were the group reporting lowest enablement. Significantly more patients with pain, skin problems and digestive problems reported social problems and significantly fewer of them reported enablement in 1992 compared with 1990. Patients with diabetes, angina, chronic bronchitis and problems seeing fared relatively well over the study period. Some patients with psychosocial problems fared poorly (they had relatively short consultations and were unlikely to express an ability to cope/understand their illness).
CONCLUSION
The issue of whether benefits to some patient groups from recent health service changes may be matched by disadvantage to other groups, for example those with clinical problems with no financial incentive to provide pro-active care or with psychosocial difficulties, is discussed.