一線照護醫師越多 年長者越健康


  【24drs.com】新研究顯示,居住在有較多受過訓練且實際提供一線照護之醫師的區域的年長美國人,和居住在執業的一線照護醫師較少的區域者相比,壽命較長且較少住院。
  
  研究人員在5月25日的美國醫學會期刊中指出,加強一線照護醫師的角色是改善美國年長者健康照護效率與結果的關鍵要素。
  
  新罕布夏達資茅斯醫學院的Chiang-Hua Chang博士等人寫道,研究發現認為,當地的一線照護醫師較多對於Medicare保戶有正面幫助,但是這並不只是某區域受過訓練的醫師人數較多而已;重點在於,受過一線照護訓練的當地醫師在社區中實際執行一線照護的量。
  
  研究人員表示,他們的分析提供了一個「注意事項」,認為一線照護的好處顯然與受過一線照護訓練的醫師和從事門診一線照護者的實際能力息息相關。
  
  Chang博士等人根據郵遞區號區分了6,542個一線照護服務區域,分析死亡率、可預防的「門診照護敏感狀況」住院率,以及在2007年、超過510萬名、65歲以上全額給付Medicare保戶的Medicare費用。
  
  相較於一線照護醫師最少的區域,醫師數最多之區域的保戶,其可預防住院率降低6%(74.90 vs 79.61/每1000名保戶;相對風險[RR]為0.94;95%信心區間[CI]為0.93 - 0.95)。
  
  可預防住院率包括慢性阻塞性肺部疾病、鬱血性心衰竭、肺炎、氣喘、高血壓、腎臟或泌尿道感染、脫水。
  
  較易獲得一線照護之保戶的死亡率也較低些 (5.38 vs 5.47 /每1000名保戶;RR,0.98;95% CI,0.97 - 0.997),但是整體Medicare計劃花費沒有差異($8722 vs $8765/每名保戶;RR,1.00;95% CI,0.99 - 1.00)。
  
  研究人員表示,使用「一線照護醫師全時當量」模式分析時的關聯比較強烈,一線照護醫師全時當量是一種可更準確測量實際一線照護程度的方法。
  
  例如,居住在一線照護醫師全時當量前五分之一區域的保戶不只死亡率低了5%(RR,0.95;95% CI,0.93 - 0.96),可預防住院率也少了9%(RR,0.91;95% CI,0.90 - 0.92),而Medicare計劃總花費則是高了1%(RR,1.01;95% CI,1.004 - 1.02)。
  
  校正一線照護醫師全時當量最高五分之一和最低五分之一的比率後進行分析,每100名保戶的死亡數分別是5.19 vs 5.49、每1000名保戶的可預防住院數是72.53 vs 79.48、每個保戶的Medicare總體花費分別是$8857 vs $8857元。
  
  Chang博士等人表示,增加家庭醫學和內科醫學的訓練量後,如果一線照護醫師只是名義上增加,那對病患幫助而言將是令人失望的。
  
  資料來源: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.

    
相關報導
過敏性鼻炎患者壽命較長
2014/3/5 下午 01:12:02
手術併發症增加癌症照護費用
2014/1/16 下午 01:42:33
定期健康檢查似乎不會影響死亡率
2013/1/22 上午 11:55:39

上一頁
   1   2   3   4   5   6   7   8  




回上一頁