护士工作与患者健康结果的关系:比较初级护理模式的观察研究。

IF 4.5 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH International Journal for Equity in Health Pub Date : 2024-10-04 DOI:10.1186/s12939-024-02288-z
Nicolette Sheridan, Karen Hoare, Jenny Carryer, Jane Mills, Sarah Hewitt, Tom Love, Timothy Kenealy
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引用次数: 0

摘要

背景:在新西兰奥特亚罗瓦的发病率和死亡率统计中,毛利人所占比例过高。其他健康需求较高的人群包括太平洋岛屿族裔和物质匮乏的人群。全科医疗已发展成为七种初级保健模式:传统模式、企业模式、保健之家模式、毛利模式、太平洋模式、信托/非政府组织模式和地区卫生局/初级保健组织模式。我们描述了与这些护理模式、高健康需求人群和患者健康结果相关的护士工作:我们对来自国家数据集和患者层面实践的数据进行了横截面研究(截至 2018 年 9 月 30 日)。我们选择了六项主要结果指标,因为它们可以通过初级保健得到改善:多药治疗(≥65 岁)、成人糖尿病患者血糖控制检测、免疫接种(6 个月)、非卧床敏感性住院(0-14 岁、45-64 岁)和急诊就诊人次。分析对患者和诊疗特点进行了调整:结果:与其他模式相比,信托/非政府组织、毛利和太平洋地区诊所的护士临床时间以及护士、执业护士和全科医生的综合临床时间要高得多。患者临床复杂性的增加与更多的临床投入和更高的所有结果测量得分有关。在毛利人、信托/非政府组织和太平洋裔诊所中,护士提供预防性护理(宫颈筛查、心血管风险评估、抑郁症筛查、血糖控制测试)的比例最高。在不同的护理模式中,护士进行抑郁症筛查的比例相差八倍,宫颈癌筛查和血糖控制测试的比例相差五倍。在PHO/DHB、太平洋地区、信托/非政府组织和毛利诊所中,护士在下班后为未登记病人提供咨询的比例最高,从而提高了就诊率。执业记录中未归属于护士的工作意味着护士的工作被低估了,低估的程度不得而知:结论:将传统诊所、保健院和企业诊所的工作转移给护士,可以腾出全科医生的临床时间从事其他工作。较差的患者健康结果与较高的患者需求和较高的临床投入有关。临床投入不足以满足患者需求的程度是有道理的。医生需要投入更多的临床时间,尤其是在诊治大量复杂病人的诊所。
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Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO). We describe nurse work in relation to these models of care, populations with high health need and patient health outcomes.

Methods: We conducted a cross-sectional study (at 30 September 2018) of data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥ 65 years), glucose control testing in adults with diabetes, immunisations (at 6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics.

Results: Nurse clinical time, and combined nurse, nurse practitioner and general practitioner clinical time, were substantially higher in Trust/NGO, Māori, and Pacific practices than in other models. Increased patient clinical complexity was associated with more clinical input and higher scores on all outcome measures. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, depression screening, glucose control testing) were in Māori, Trust/NGO and Pacific practices. There was an eightfold difference, across models of care, in percentage of depression screening undertaken by nurses and a fivefold difference in cervical screening and glucose control testing. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree.

Conclusions: Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release general practitioner clinical time for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner clinical time is required, especially in practices with high volumes of complex patients.

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来源期刊
CiteScore
7.80
自引率
4.20%
发文量
162
审稿时长
28 weeks
期刊介绍: International Journal for Equity in Health is an Open Access, peer-reviewed, online journal presenting evidence relevant to the search for, and attainment of, equity in health across and within countries. International Journal for Equity in Health aims to improve the understanding of issues that influence the health of populations. This includes the discussion of political, policy-related, economic, social and health services-related influences, particularly with regard to systematic differences in distributions of one or more aspects of health in population groups defined demographically, geographically, or socially.
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