一线照护医师越多 年长者越健康


  【24drs.com】新研究显示,居住在有较多受过训练且实际提供一线照护之医师的区域的年长美国人,和居住在执业的一线照护医师较少的区域者相比,寿命较长且较少住院。
  
  研究人员在5月25日的美国医学会期刊中指出,加强一线照护医师的角色是改善美国年长者健康照护效率与结果的关键要素。
  
  新罕布夏达资茅斯医学院的Chiang-Hua Chang博士等人写道,研究发现认为,当地的一线照护医师较多对于Medicare保户有正面帮助,但是这并不只是某区域受过训练的医师人数较多而已;重点在于,受过一线照护训练的当地医师在社区中实际执行一线照护的量。
  
  研究人员表示,他们的分析提供了一个「注意事项」,认为一线照护的好处显然与受过一线照护训练的医师和从事门诊一线照护者的实际能力息息相关。
  
  Chang博士等人根据邮递区号区分了6,542个一线照护服务区域,分析死亡率、可预防的「门诊照护敏感状况」住院率,以及在2007年、超过510万名、65岁以上全额给付Medicare保户的Medicare费用。
  
  相较于一线照护医师最少的区域,医师数最多之区域的保户,其可预防住院率降低6%(74.90 vs 79.61/每1000名保户;相对风险[RR]为0.94;95%信心区间[CI]为0.93 - 0.95)。
  
  可预防住院率包括慢性阻塞性肺部疾病、郁血性心衰竭、肺炎、气喘、高血压、肾脏或泌尿道感染、脱水。
  
  较易获得一线照护之保户的死亡率也较低些 (5.38 vs 5.47 /每1000名保户;RR,0.98;95% CI,0.97 - 0.997),但是整体Medicare计划花费没有差异($8722 vs $8765/每名保户;RR,1.00;95% CI,0.99 - 1.00)。
  
  研究人员表示,使用「一线照护医师全时当量」模式分析时的关联比较强烈,一线照护医师全时当量是一种可更准确测量实际一线照护程度的方法。
  
  例如,居住在一线照护医师全时当量前五分之一区域的保户不只死亡率低了5%(RR,0.95;95% CI,0.93 - 0.96),可预防住院率也少了9%(RR,0.91;95% CI,0.90 - 0.92),而Medicare计划总花费则是高了1%(RR,1.01;95% CI,1.004 - 1.02)。
  
  校正一线照护医师全时当量最高五分之一和最低五分之一的比率后进行分析,每100名保户的死亡数分别是5.19 vs 5.49、每1000名保户的可预防住院数是72.53 vs 79.48、每个保户的Medicare总体花费分别是$8857 vs $8857元。
  
  Chang博士等人表示,增加家庭医学和内科医学的训练量后,如果一线照护医师只是名义上增加,那对病患帮助而言将是令人失望的。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_logon=W&x_idno=6533&x_classno=0
  

More Practicing PCPs Means Healthier Seniors

By Megan Brooks
Medscape Medical News

May 26, 2011 — Aging Americans who live in areas with greater access to physicians trained in and actually providing primary care may live a bit longer and be hospitalized less often than their peers who live in areas with fewer practicing primary care physicians, new research shows.

"Strengthening the role of primary care is a key element in most proposals to improve the outcomes and efficiency of health care delivery in the United States," the researchers note in the May 25 issue of the Journal of the American Medical Association.

"Our findings suggest that a higher local workforce of primary care physicians has a generally positive benefit for Medicare populations, but that this association may not simply be the result of having more physicians trained in primary care in an area," write Chiang-Hua Chang, PhD, from Dartmouth Medical School, Hanover, New Hampshire, and colleagues.

What seems to be important, they found, is the amount of primary care actually delivered in the community by local physicians who are trained in primary care.

Their analysis, the researchers say, offers a "cautionary note" by suggesting that the benefits of a primary care workforce "appear quite sensitive to the accurate discrimination of those physicians trained in primary care with those practicing ambulatory primary care."

Study of 5 Million Medicare Recipients

Dr. Chang and colleagues analyzed death rates, hospitalizations for preventable "ambulatory care sensitive conditions," and Medicare spending for more than 5.1 million fee-for-service Medicare beneficiaries aged 65 years or older in 2007 residing in 6542 primary care service areas, defined by Zip code.

Compared with areas with the lowest number of primary care physicians, beneficiaries in areas with the highest number had 6% lower rates of preventable hospitalizations (74.90 vs 79.61 per 1000 beneficiaries; relative rate [RR], 0.94; 95% confidence interval [CI], 0.93 - 0.95).

The preventable hospitalizations included those for chronic obstructive pulmonary disease, congestive heart failure, pneumonia, asthma, hypertension, kidney or urinary infection, and dehydration.

Beneficiaries with greater access to primary care also had somewhat lower rates of mortality (5.38 vs 5.47 per 100 beneficiaries; RR, 0.98; 95% CI, 0.97 - 0.997), but no difference in total Medicare program spending ($8722 vs $8765 per beneficiary; RR, 1.00; 95% CI, 0.99 - 1.00).

The associations were stronger, the researchers say, in models that used primary care physician full-time equivalents — a workforce measure that provides a more accurate measure of actual primary care delivered.

For example, not only did beneficiaries residing in the highest quintile of primary care full-time equivalents have 5% lower mortality (RR, 0.95; 95% CI, 0.93 - 0.96) but they also had 9% fewer preventable hospitalizations (RR, 0.91; 95% CI, 0.90 - 0.92) and 1% higher total Medicare program spending (RR, 1.01; 95% CI, 1.004 - 1.02) than beneficiaries in other regions.

The adjusted rates for the highest compared with the lowest quintile of primary care full-time equivalents were 5.19 vs 5.49 deaths per 100 beneficiaries, 72.53 vs 79.48 preventable hospitalizations per 1000 beneficiaries, and $8857 vs $8769 total Medicare spending per beneficiary, respectively.

This study, Dr. Chang and colleagues say, suggests that "increasing the training capacity of family medicine and internal medicine may have disappointing patient benefits if the resulting physicians are primary care in name only."

The study was supported in part by the Robert Wood Johnson Foundation and the National Institute on Aging. One author has received speaking fees from a variety of nonprofit and for-profit organizations; Dr. Chang and the other authors have disclosed no relevant financial relationships.

JAMA. 2011;305:2096-2105.

    
相关报导
过敏性鼻炎患者寿命较长
2014/3/5 下午 01:12:02
手术并发症增加癌症照护费用
2014/1/16 下午 01:42:33
定期健康检查似乎不会影响死亡率
2013/1/22 上午 11:55:39

上一页
   1   2   3   4   5   6   7   8  




回上一页