Multidisciplinary care planning in the primary care management of completed stroke: a systematic review
Multidisciplinary care planning in the primary care management of completed stroke: a systematic review
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DOI：
10.1186/1471-2296-9-44
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发表时间：
2008-08-05
影响因子：
2.9
通讯作者：
Tieman, Jennifer J.
中科院分区：
文献类型：
--
作者：
Mitchell, Geoffrey K.;Brown, Robyn M.;Tieman, Jennifer J.
背景：慢性病管理需要多名卫生专业人员的投入，包括专科和初级保健提供者。本研究旨在评估协调多学科护理在初级保健中的影响，以初级保健团队提供正式护理计划或在初级-二级团队之间共享为代表，相对于常规护理，对卒中结果的影响。方法:对Medline、EMBASE、CINAHL（全部1990-2006年）、Cochrane图书馆（2006年第1期）和基于网络搜索CCOHA健康技术评估清单分析中列出的网站的灰色文献进行系统回顾，对随机和非随机试验的结果进行叙述性分析。观察性和定性研究在初级保健环境中完成卒中患者，其中护理计划由1)多学科初级保健团队或2)通过初级和二级提供者共享护理进行。结果：共检索文献1445篇。纳入18篇论文进行分析。大多数护理计划都是在医院开展多学科小组护理，并向社区患者提供服务。死亡率不受多学科护理计划的影响。这些研究的功能结果不一致。目前尚不清楚全科医生和其他初级保健专业人员在多学科护理计划中的积极参与是否有助于研究结果显示出积极的影响。包括初级保健专业人员和全科医生在内的多学科护理计划可能会带来过程效益。很少有研究真正描述了全科医生完成的任务和角色，以及这是否与假定提供的相符。结论：虽然多学科护理计划可能不能明确地改善卒中患者的护理，但可能存在过程益处，例如改善提供者之间的任务分配。对全科医生积极参与多学科护理计划的影响的进一步研究是必要的。
Background: Chronic disease management requires input from multiple health professionals, both specialist and primary care providers. This study sought to assess the impact of co-ordinated multidisciplinary care in primary care, represented by the delivery of formal care planning by primary care teams or shared across primary-secondary teams, on outcomes in stroke, relative to usual care.Methods: A Systematic review of Medline, EMBASE, CINAHL (all 1990-2006), Cochrane Library (Issue 1 2006), and grey literature from web based searching of web sites listed in the CCOHA Health Technology Assessment List Analysis used narrative analysis of findings of randomised and non-randomised trials, and observational and qualitative studies of patients with completed stroke in the primary care setting where care planning was undertaken by 1) a multi-disciplinary primary care team or 2) through shared care by primary and secondary providers.Results: One thousand and forty-five citations were retrieved. Eighteen papers were included for analysis. Most care planning took part in the context of multidisciplinary team care based in hospitals with outreach to community patients. Mortality rates are not impacted by multidisciplinary care planning. Functional outcomes of the studies were inconsistent. It is uncertain whether the active engagement of GPs and other primary care professionals in the multidisciplinary care planning contributed to the outcomes in the studies showing a positive effect. There may be process benefits from multidisciplinary care planning that includes primary care professionals and GPs. Few studies actually described the tasks and roles GPs fulfilled and whether this matched what was presumed to be provided.Conclusion: While multidisciplinary care planning may not unequivocally improve the care of patients with completed stroke, there may be process benefits such as improved task allocation between providers. Further study on the impact of active GP involvement in multidisciplinary care planning is warranted.