Medication risk management and health equity in New Zealand general practice: a retrospective cross-sectional study.
Medication risk management and health equity in New Zealand general practice: a retrospective cross-sectional study.
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新西兰一般实践中的药物风险管理和健康平等：回顾性横断面研究。
DOI：
10.1186/s12939-021-01461-y
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发表时间：
2021-05-11
影响因子：
4.8
通讯作者：
Stokes T
中科院分区：
文献类型：
--
作者：
Leitch S;Zeng J;Smith A;Stokes T
尽管公开致力于公平，但新西兰各地的健康不平等现象仍然很明显。开发了一种通用电子警报系统，以通知临床医生患者因其先前存在的医疗状况或当前的药物治疗而受到伤害的风险。我们的目的是确定临床医生根据患者种族或其他人口统计因素采取的警报行动是否存在差异。来自新西兰各地的 66 家全科诊所参加了此次活动。提供了 2018 年 1 月至 2019 年 7 月 1 日期间为 1582 名患者检测到的 1611 个警报的数据。主要结果是警报后是否采取了行动。使用逻辑回归来评估某一种族群体的患者是否更有可能采取行动。分析中考虑的潜在混杂因素包括患者年龄、性别、种族、社会经济剥夺、长期诊断数量和长期药物治疗数量。没有证据表明不同种族群体采取行动的几率存在差异，但与欧洲群体相比，毛利人和太平洋岛民患者的估计几率较低（毛利人 OR 0.88，95%CI 0.63–1.22；太平洋岛民 OR 0.88，95%CI 0.52–1.49）。与男性相比，女性采取行动的几率明显较低（OR 0.76，95%CI 0.59–0.96）。对新西兰一般实践电子警报系统产生的数据的分析发现，临床医生通常会对这些警报采取行动。然而，临床医生似乎对女性、毛利人和太平洋岛民患者采取的行动较少。使用有针对性的警报系统有可能降低药物相关伤害的风险。认识到临床医生的偏见可以改善医疗保健提供的公平性。在线版本包含可在 10.1186/s12939-021-01461-y 获取的补充材料。
Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient’s risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63–1.22; Pasifika OR 0.88, 95 %CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59–0.96). This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision. The online version contains supplementary material available at 10.1186/s12939-021-01461-y.
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影响因子：
105.7
作者：
Kwan, Janice L.;Lo, Lisha;Shojania, Kaveh G.
通讯作者：
Shojania, Kaveh G.
影响因子：
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作者：
Samulowitz, Anke;Gremyr, Ida;Hensing, Gunnel
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168.9
作者：
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通讯作者：
Scott, Alastair
影响因子：
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作者：
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通讯作者：
Mills, Angela M.
影响因子：
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作者：
Jatrana, Santosh;Crampton, Peter
通讯作者：
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