Availability and structure of primary medical care services and population health and health care indicators in England
Availability and structure of primary medical care services and population health and health care indicators in England
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DOI：
10.1186/1472-6963-4-12
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发表时间：
2004-06-11
影响因子：
2.8
通讯作者：
Ukoumunne, OC
中科院分区：
文献类型：
--
作者：
Gulliford, MC;Jack, RH;Ukoumunne, OC
背景：有人提出，更多的初级医疗保健从业人员（GP）的可用性有助于更好的人口健康。我们评估措施的供应和结构的初级医疗服务是否与健康和卫生保健指标调整后confounding.Methods：数据的供应和结构的初级医疗服务和注册患者的特点进行了分析，为99个卫生当局在英格兰于1999年。作为因变量的健康和保健指标包括标准化死亡率、标准化住院率和18岁以下的怀孕率。线性回归分析进行了调整汤森评分，少数民族的比例和社会阶层IV/V的比例。结果：较高比例的登记农村患者和患者大于或等于75岁与较低的汤森剥夺分数，更大的合作伙伴规模和更好的健康结果。合伙企业规模每增加一个单位，15-64岁全因死亡率的SMR就会减少4.2（95%置信区间1.7至6.7）个单位（P = 0.001）。单手练习增加10%与SMR增加1.5（0.2至2.9）个单位相关（P = 0.027）。在对农村和老年患者的百分比、合作伙伴的规模和单手实践的比例进行额外调整后，GP供应与SMR无关（-2.8，-6.9 to 1.3，P = 0.183）。在调整人口健康需求的混杂因素后，死亡率是弱相关的程度组织的做法所代表的伙伴关系的大小，但不与供应的全科医生。
Background: It has been proposed that greater availability of primary medical care practitioners (GPs) contributes to better population health. We evaluated whether measures of the supply and structure of primary medical services are associated with health and health care indicators after adjusting for confounding.Methods: Data for the supply and structure of primary medical services and the characteristics of registered patients were analysed for 99 health authorities in England in 1999. Health and health care indicators as dependent variables included standardised mortality ratios (SMR), standardised hospital admission rates, and conceptions under the age of 18 years. Linear regression analyses were adjusted for Townsend score, proportion of ethnic minorities and proportion of social class IV/V.Results: Higher proportions of registered rural patients and patients greater than or equal to 75 years were associated with lower Townsend deprivation scores, with larger partnership sizes and with better health outcomes. A unit increase in partnership size was associated with a 4.2 (95% confidence interval 1.7 to 6.7) unit decrease in SMR for all-cause mortality at 15-64 years (P = 0.001). A 10% increase in single-handed practices was associated with a 1.5 (0.2 to 2.9) unit increase in SMR (P = 0.027). After additional adjustment for percent of rural and elderly patients, partnership size and proportion of single-handed practices, GP supply was not associated with SMR (-2.8, -6.9 to 1.3, P = 0.183).Conclusions: After adjusting for confounding with health needs of populations, mortality is weakly associated with the degree of organisation of practices as represented by the partnership size but not with the supply of GPs.