特发性颅内高压跨学科一站式专科门诊--患者满意度综合评估

Gabriel Bsteh, Stefan Macher, Nik Krajnc, Wolfgang Marik, Martin Michl, Nina Müller, Sina Zaic, Jürgen Harreiter, Klaus Novak, Christian Wöber, Berthold Pemp
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摘要

特发性颅内高压(IIH)的治疗非常复杂,需要多个专业学科的参与。在实践中,这给组织和沟通带来了相当大的挑战。为了应对这些挑战,我们建立了一个跨学科的特发性颅内高压综合门诊,由中央协调并采用一站式服务理念。在此,我们旨在评估这种一站式理念对 IIH 患者主观满意度和经济效益的影响。在一项回顾性队列研究中,我们比较了一站式综合护理时代(IC,2021 年 7 月 1 日至 2022 年 12 月 31 日)与接受标准护理的参照组(SC,2018 年 7 月 1 日至 2019 年 12 月 31 日)在患者主观满意度(通过维也纳患者量表进行评估)方面的情况。多变量二元线性回归模型用于调整混杂因素。IC组(n = 85)和SC组(n = 81)的基线特征具有可比性(女性:90.6% vs. 90.1%;平均年龄:33.6 vs. 32.8岁;教育程度:≥9年教育的60.0% vs. 59.3%;位于维也纳的75.3% vs. 76.5%)。与 SC 相比,IC 概念下的管理与患者主观满意度(β = 0.93;p < 0.001)显著相关,其中对治疗可及性和可用性满意度的影响最大(β = 2.05;p < 0.001)。对有移民背景和语言障碍的患者进行的分组分析表明,综合治疗在这些群体中的效果更强。对 IIH 进行跨学科综合管理,从统计学和临床意义上讲都能显著提高患者的满意度,尤其是对社会经济条件较差的患者群体。提供结构化的中央协调以促进和改善跨学科管理,为进一步改善疗效提供了手段。
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An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension – a comprehensive assessment of patient satisfaction
Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop concept. Here, we aimed to evaluate effects of this one-stop concept on subjective patient satisfaction and economic outcome in patients with IIH. In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding subjective patient satisfaction (assessed by the Vienna Patient Inventory). Multivariable binary linear regression models were used to adjust for confounders. Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, management within IC concept was associated with statistically significantly higher subjective patient satisfaction (beta = 0.93; p < 0.001) with the strongest effects observed in satisfaction with treatment accessibility and availability (beta = 2.05; p < 0.001). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of IC in these groups. Interdisciplinary integrated management of IIH statistically significantly and clinically meaningfully improves patient satisfaction – particularly in socioeconomically underprivileged patient groups. Providing structured central coordination to facilitate and improve access to interdisciplinary management provides means to further improve outcome.
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