Effects of non-medical health coaching on multimorbid patients in primary care: a difference-in-differences analysis
Effects of non-medical health coaching on multimorbid patients in primary care: a difference-in-differences analysis
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DOI：
10.1186/s12913-019-4367-8
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发表时间：
2019-08-22
影响因子：
2.8
通讯作者：
Sutton, Matt
中科院分区：
文献类型：
--
作者：
Shah, Vishalie;Stokes, Jonathan;Sutton, Matt
卫生系统，在全球范围内，正试图加强初级保健，以促进人口健康管理的方法来提供护理，鼓励预防和自我管理。本文评估了“加强初级保健”模式在英格兰的地理区域实施。加强初级保健引入了一个新的非医疗角色，健康教练，传统的初级保健团队提供额外的支持，慢性病患者。我们使用准实验评估健康指导对患者结局的影响。我们使用2013年至2017年全国全科医生患者调查的350万受访者的数据，估计该计划对健康状况（EQ-5D-5L，身体功能，心理健康和弹性），健康行为（吸烟习惯），护理经验（以人为本和护理的连续性）和医疗保健（初级保健）利用率的影响。我们使用一个加权的差异差异设计，比较结果的变化，随着时间的推移，干预措施和可比的控制措施，在英格兰其他地区。我们对多病患者进行了主要分析，并对所有患者进行了额外分析，以评估人群水平的影响。结果对于多病患者，我们发现心理健康（短期和中期）下降了-0.0174（95%置信区间-0.0283至-0.0065），与干预前平均值相比相对差异为-2%;以人为本（短期）为-0.0356（-0.0530至-0.0183），-4%。我们发现对其他结果指标没有显著影响。对于人群水平的影响，在短期内，我们发现初级保健利用率下降了-0.0331（-0.0448至-0.0214），-5%。所有其他结局均不具有统计学显著性。结论我们的研究结果表明，在短期到中期（最多14个月），健康指导对患者的体验和结果的影响很小。引入增强型初级保健与多病患者的心理健康和以人为本的程度略低相关（患者最初可能难以适应该模式）。然而，这也与人口水平的初级保健就诊率下降有关（可能会为更复杂的患者腾出医生时间）。结果提出了重要的问题，初级保健劳动力的变化主张在国民保健服务长期计划，以及任何预防策略的好处的时间范围。
Background Health systems, globally, are attempting to strengthen primary care to promote a population-health management approach to care provision, incentivising prevention and self-management. This paper evaluates the "Enhanced Primary Care" model implemented in a geographical region in England. Enhanced Primary Care introduces a new non-medical role, health coaches, to the traditional primary care team to provide additional support for patients with chronic conditions. We evaluate effects of health coaching on patient outcomes using a quasi-experiment. Methods We estimate the programme's effects on health status (EQ-5D-5L, physical functioning, psychological wellbeing, and resilience), health behaviour (smoking habit), experience of care (person-centeredness and continuity of care), and health care (primary care) utilisation using data from 3.5 million respondents to the national GP Patient Surveys between 2013 and 2017. We use a weighted difference-in-differences design to compare changes in outcomes over time between intervention practices and comparable control practices in the rest of England. We conduct our main analysis on multimorbid patients and additional analysis on all patients to assess population-level effects. Results For multimorbid patients, we find reductions in psychological wellbeing (short and medium term) of -0.0174 (95% confidence interval -0.0283 to -0.0065), relative difference -2% from the pre-intervention mean; and person-centeredness (short term) of -0.0356 (-0.0530 to -0.0183), -4%. We find no significant effects on other outcome measures. For population-level effects, in the short term we find reductions in primary care utilisation of -0.0331 (-0.0448 to -0.0214), -5%. All other outcomes are not consistently statistically significant. Conclusions Our results show that there is very little effect of health coaching on patient experience and outcomes in the short-to-medium term (up to 14 months). Introduction of Enhanced Primary Care was associated with slightly lower psychological wellbeing and person-centeredness amongst multimorbid patients (it might be initially difficult for patients to adjust to the model). However, it was also associated with a decline in primary care visits at the population-level (potentially freeing up practitioner time for more complex patients). The results raise important questions regarding primary care workforce changes advocated in the NHS Long Term Plan, and the time horizon of any benefits of prevention strategies.