Healthcare utilization in women after abdominal surgery for ovarian cancer.
Healthcare utilization in women after abdominal surgery for ovarian cancer.
复制标题
卵巢癌腹部手术后女性的医疗保健利用。
DOI：
10.1097/nnr.0b013e3181ff77e4
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发表时间：
2011
期刊：
影响因子：
2.5
通讯作者：
Schwartz,Peter
中科院分区：
文献类型：
--
作者：
McCorkle,Ruth;Jeon,Sangchoon;Ercolano,Elizabeth;Schwartz,Peter
背景：接受卵巢癌手术的女性病情严重，并且是卫生服务的高使用者。使用率增加的原因是用于治疗卵巢癌的多种方式以及这些治疗带来的并发症和副作用。目的：本研究的目的是评估高级执业护士和精神科咨询联络护士对患者自我报告的医疗保健利用情况提供的干预措施与对疑似诊断为卵巢癌而接受手术的女性进行注意力控制干预措施的有效性。方法：采用两组实验性纵向设计来比较随机分配到干预组的女性或术后 48 小时内以及术后 1、3 和 6 个月内的基线注意力对照组。医疗保健利用率通过自我报告的住院和门诊就诊次数来衡量，包括急诊室就诊、肿瘤门诊就诊和初级保健就诊。护士干预包括 16 种接触：症状管理、咨询、教育、直接护理、资源协调和转诊。注意力控制干预措施包括九名联系人，其中包括使用症状管理工具包的说明以及如何管理症状的策略。结果：两组之间的住院治疗和肿瘤门诊就诊没有差异。这项研究的主要发现是两组之间的初级保健就诊次数存在显着差异。注意力对照组的女性比干预组更频繁地去看初级保健提供者。报告访问次数较多的女性也报告了更多的抑郁症状。此外，两组之间急诊室就诊的次数也存在趋势。干预组更频繁地去急诊室，因为当患者发现下班后需要紧急护理的症状时，护士会指示患者去急诊室。讨论：干预组中的女性在下班后适当地使用急诊室来处理她们的问题，而注意力对照组中更多的女性报告了更多的初级保健就诊。这些发现凸显了代表不同学科的医疗保健提供者需要协调跨专业的服务，特别是对于有抑郁症状的女性。
Background:Women undergoing surgery for ovarian cancer are severely ill and are high users of health services. Contributing to these increased utilization rates are the multiple modalities used to treat ovarian cancer and the complications and side effects from those treatments.Objective:The purpose of this study was to evaluate the effectiveness of an intervention provided by advanced practice nurses and a psychiatric consultation-liaison nurse on patients' self-report of healthcare utilization compared with an attention control intervention in women undergoing surgery for a suspected diagnosis of ovarian cancer.Methods:A two-group, experimental, longitudinal design was used to compare women who were assigned randomly to the intervention group or to an attention control group at baseline within 48 hours after surgery and 1, 3, and 6 months after surgery. Healthcare utilization was measured as the number of self-reported inpatient admissions and outpatient visits, including emergency room visits, oncology outpatient visits, and primary care visits. Nurse interventions consisted of 16 contacts: symptom management, counseling, education, direct nursing care, coordination of resources, and referrals. The attention control interventions consisted of nine contacts that included instructions on use of a symptom management toolkit and strategies on how to manage symptoms.Results:There were no differences in hospitalizations and oncology outpatient visits between the two groups. The main finding of this study was a significant difference in the number of primary care visits between the two groups. Women in the attention control group went to their primary care providers more often than the intervention group. The women who reported more visits also reported more depressive symptoms. In addition, a trend was found in the number of emergency room visits between the two groups. The intervention group visited the emergency room more often because the nurse instructed patients to go when they recognized symptoms that needed urgent care after hours.Discussion:Women in the intervention group appropriately used the emergency room to manage their problems after hours, whereas more women in the attention control group reported significantly more primary care visits. These findings highlight the need for healthcare providers representing various disciplines to coordinate services across specialties, especially for women who have depressive symptoms.