Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan.
Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan.
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DOI：
10.1136/bmjopen-2021-054348
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发表时间：
2022-01-07
期刊：
影响因子：
2.9
通讯作者：
Matsushima M
中科院分区：
文献类型：
--
作者：
Aoki T;Fujinuma Y;Matsushima M
支持初级保健结构对复杂多发性硬化症患者的护理质量的影响的证据是稀缺的，这是初级保健面临的最重要的挑战之一。本研究旨在研究复杂多发性硬化患者的多药治疗和患者报告指标与初级保健设施类型的相关性，重点是社区诊所和医院之间的差异。多中心横断面研究。共有25个初级保健设施（19个社区诊所和6个中小型医院）。患有复杂多病的成年门诊患者，其定义为一个人同时患有三种或多种慢性疾病，影响三个或更多不同的身体系统。多药治疗、使用日本版初级保健评估工具简表（JPCAT-SF）的患者报告经验测量和使用自测健康状态（SRH）的患者报告结局测量。对492例复杂性多发性硬化患者的数据进行了分析。调整可能的混杂因素和设施内的集群后，以诊所为基础的初级保健实践与以医院为基础的初级保健实践相比，多药治疗的患病率较低，JPCAT-SF在协调和社区定位方面的得分较高，以及不良或公平的SRH患病率较低。相比之下，在第一次接触的JPCAT-SF评分显着较低，在临床为基础的做法。初级保健设施的类型和JPCAT-SF评分的一致性和全面性之间的关联没有统计学意义。与以医院为基础的初级保健实践相比，以诊所为基础的初级保健实践与多种药物的患病率较低、患者协调和社区定位的体验更好以及复杂多发病患者的SRH更好相关。在初级保健环境中，小型和紧密的团队可能会提高复杂多发性硬化症患者的护理质量。
Evidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals. Multicentre cross-sectional study. A total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals). Adult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person. Polypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH). Data were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant. Clinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.
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影响因子：
2.9
作者：
Harrison C;Britt H;Miller G;Henderson J
通讯作者：
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影响因子：
2.1
作者：
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Airaksinen, Marja
影响因子：
120.7
作者：
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通讯作者：
GERSTENBERGER, A
影响因子：
1.1
作者：
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通讯作者：
Regan, J
影响因子：
2.8
作者：
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通讯作者：
Sutton, Matt