A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing.
A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing.
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DOI：
10.1186/1472-6963-13-336
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发表时间：
2013-08-26
影响因子：
2.8
通讯作者：
McDermott RA
中科院分区：
文献类型：
--
作者：
Gibson OR;Segal L;McDermott RA
初级卫生保健被认为是国家卫生保健系统的一个组成部分。通过高质量和可获得的初级保健，可以避免住院，衡量住院是初级保健服务表现如何的一个指标。本综述关注慢性病相关住院与初级卫生保健资源之间的关系。如果研究经过同行评审，以英语撰写，发表于2002年至2012年间，将住院建模为PHC资源的函数，并将2型糖尿病住院确定为研究结果指标，则纳入研究。获得和使用初级保健服务被用作初级保健资源的替代。排除了对主要使用者付费系统人群的研究，以消除患者获得和利用PHC的经济障碍。根据纳入标准系统性排除文献，以获得最终的研究集进行审查。检索策略使用EconLit、Medline和Google Scholar数据库识别出1778篇潜在文章。10篇文章符合纳入标准，并接受审查。PHC资源通过劳动力（医疗或护理）数量、初级保健事件数量、服务可用性（例如，营业时间）、初级保健实践规模（例如，单个或小组执业医生实践-较大的实践现场有更多的护理学科）或提高糖尿病护理质量的财务激励来量化。医务人员数量和ACSC住院之间的关联是混合的。六项研究中有四项发现，每名医生的患者人数减少与门诊护理敏感性住院的减少显著相关，一项研究发现相反，一项研究没有发现两者之间的显著相关性。当结果按PHC获得（例如，GP/人均，服务范围）和使用（例如，门诊次数）分类时，更好地获得优质PHC导致ACSC住院较少。当只对调整了健康状况的研究进行分类时，这一发现仍然存在。在一项研究中报告，提高糖尿病护理质量的经济激励与ACSC住院率降低相关。在PHC资源和ACSC住院之间的关系的12项指标中，有7项具有显著的负相关性。作为一个集体的证据，这些研究提供了非决定性的支持，即更多的PHC资源与ACSC的住院减少有关。在调整健康状况后，改善或增加PHC访问的特征与ACSC住院次数减少呈负相关。住院治疗、PHC资源和健康状况的不同措施可能会导致研究结果不一致，并使研究结果难以解释。
Primary health care is recognised as an integral part of a country’s health care system. Measuring hospitalisations, that could potentially be avoided with high quality and accessible primary care, is one indicator of how well primary care services are performing. This review was interested in the association between chronic disease related hospitalisations and primary health care resourcing. Studies were included if peer reviewed, written in English, published between 2002 and 2012, modelled hospitalisation as a function of PHC resourcing and identified hospitalisations for type 2 diabetes as a study outcome measure. Access and use of PHC services were used as a proxy for PHC resourcing. Studies in populations with a predominant user pay system were excluded to eliminate patient financial barriers to PHC access and utilisation. Articles were systematically excluded based on the inclusion criteria, to arrive at the final set of studies for review. The search strategy identified 1778 potential articles using EconLit, Medline and Google Scholar databases. Ten articles met the inclusion criteria and were subject to review. PHC resources were quantified by workforce (either medical or nursing) numbers, number of primary care episodes, service availability (e.g. operating hours), primary care practice size (e.g. single or group practitioner practice—a larger practice has more care disciplines onsite), or financial incentive to improve quality of diabetes care. The association between medical workforce numbers and ACSC hospitalisations was mixed. Four of six studies found that less patients per doctor was significantly associated with a decrease in ambulatory care sensitive hospitalisations, one study found the opposite and one study did not find a significant association between the two. When results were categorised by PHC access (e.g. GPs/capita, range of services) and use (e.g. n out-patient visits), better access to quality PHC resulted in fewer ACSC hospitalisations. This finding remained when only studies that adjusted for health status were categorised. Financial incentives to improve the quality of diabetes care were associated with less ACSC hospitalisations, reported in one study. Seven of 12 measures of the relationship between PHC resourcing and ACSC hospitalisations had a significant inverse association. As a collective body of evidence the studies provide inconclusive support that more PHC resourcing is associated with reduced hospitalisation for ACSC. Characteristics of improved or increased PHC access showed inverse significant associations with fewer ACSC hospitalisations after adjustment for health status. The varied measures of hospitalisation, PHC resourcing, and health status may contribute to inconsistent findings among studies and make it difficult to interpret findings.
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影响因子：
2.8
作者：
Gulliford, MC;Jack, RH;Ukoumunne, OC
通讯作者：
Ukoumunne, OC
影响因子：
2.3
作者：
Bottle, Alex;Millett, Christopher;Majeed, Azeem
通讯作者：
Majeed, Azeem
影响因子：
2.5
作者：
FLEMING, ST
通讯作者：
FLEMING, ST
影响因子：
5.4
作者：
Lavoie, Josee Gabrielle;Forget, Evelyn L.;O'Neil, John D.
通讯作者：
O'Neil, John D.
影响因子：
2.8
作者：
Gibson OR;Segal L;McDermott RA
通讯作者：
McDermott RA