瞿氏初级医疗改革后慢性病患者和非慢性病患者护理经验的演变。

International Journal of Chronic Diseases Pub Date : 2016-01-01 Epub Date: 2016-04-07 DOI:10.1155/2016/2497637
Raynald Pineault, Roxane Borgès Da Silva, Sylvie Provost, Mylaine Breton, Pierre Tousignant, Michel Fournier, Alexandre Prud'homme, Jean-Frédéric Levesque
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引用次数: 3

摘要

目标。评估在魁北克省两个地区实施的新的初级卫生保健(PHC)模式与其他形式的初级卫生保健做法相比,在多大程度上改善了患者的护理体验、未满足的需求以及患有和不患有慢性病的个人的服务使用情况。方法。在2005年和2010年,我们进行了人口和组织调查。我们将初级保健组织分为新模式实践和其他实践,并跟踪患者护理经验的演变。结果。在这两个时期,慢性病患者在新模式实践中有更好的可及性,但护理的连续性较差。通过改革,两组的可及性平均下降,但其他实践的连续性和感知结果改善更多。在新的模式实践中,初级保健服务的使用减少得更多。在没有慢性疾病的患者中,新模型的可及性降低得更少,反应性增加得更多。急诊室的出勤率和住院率没有显著变化。结论。患者护理经验的演变对无慢性疾病的患者更有利。这些发现引起了对公平的关注,因为初级保健改革的目标是优先针对最需要的个人。
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Evolution of Experience of Care of Patients with and without Chronic Diseases following a Québec Primary Healthcare Reform.

Objectives. To assess the extent to which new primary healthcare (PHC) models implemented in two regions of Quebec have improved patient experience of care, unmet needs, and use of services for individuals with and without chronic diseases, compared with other forms of PHC practices. Methods. In 2005 and 2010, we carried out population and organization surveys. We divided PHC organizations into new model practices and other practices and followed the evolution over time of patient experience of care. Results. Patients with chronic diseases had better accessibility but worse continuity of care in the new model practices than in the other practices at both time periods. Through the reform, accessibility decreased evenly in both groups, but continuity and perceived outcomes improved more in the other practices. Use of primary care services decreased more in the new model practices. Among patients without chronic disease, accessibility decreased much less in the new models and responsiveness increased more. There was no significant change in ER attendance and hospitalization. Conclusion. The evolution of patient experience of care has been more favorable for patients without chronic diseases. These findings raise concerns about equity since the aim of the PHC reform was targeting in priority individuals with the greatest needs.

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