阿根廷为居住在家中的体弱老年人实施的保健和社会护理一体化方案的有效性

G. Perman, Mariana Prevettoni, Tami Guenzelovich, M. Schapira, Verónica Martínez Infantino, Roxana Ramos, J. Saimovici, Cristian Gallo, M. Ferre, Silvana Scozzafava, Lucila Hornstein, L. Garfi
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引用次数: 3

摘要

对居家体弱长者的综合照护措施是否有效,尚无定论。有必要进行更多的研究,特别是在发展中国家。我们的目的是评估健康和社会护理整合方案与迄今为止最佳护理标准在这一人群中的有效性。方法在阿根廷布宜诺斯艾利斯市患者家中进行准实验研究。干预组有一名健康和社会护理顾问,根据结构化过程系统地审查社会和生物状况,评估:功能、营养、活动能力、疼痛、认知、药物调节和依从性、护理需求、护理质量和环境安全。对照组得到了迄今为止最好的护理标准,可以获得同样的保健或社会护理服务,但没有辅导员和相关程序。主要结局是使用cox比例风险模型计算一年后住院的调整风险比。结果每组共入组121人。与对照组比较,干预组入院的粗风险比为0.622 (95% CI: 0.427-0.904;p = 0.013)。校正风险比(aHR)为0.503 (95% CI: 0.340-0.746;p = 0.001)。死亡aHR为0.993 (95% CI: 0.492-2.002;p = 0.984)。生活质量的绝对差异为16.59分(95% CI: 12.03-21.14;p < 0.001)。与常规护理相比,融合方案的住院率更低,生活质量更好。两组的死亡率没有显著差异。
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Effectiveness of a health and social care integration programme for home-dwelling frail older persons in Argentina
Introduction The evidence of effectiveness of integrated care initiatives for home-dwelling frail older persons is still inconclusive. There is a need for more studies, especially in developing countries. Our objective was to assess the effectiveness of a health and social care integration programme versus the best standard of care to date in this population. Methods Quasi-experimental study performed in patients' homes in Buenos Aires, Argentina. The intervention arm had a health and social care counsellor that systematically reviewed the social and biological situation following a structured process, evaluating: functionality, nutrition, mobility, pain, cognition, medication reconciliation and adherence, need for care, quality of care, and environmental safety. The control group received the best standard of care to date, with access to the same health or social care services, but without the counsellor and related processes. The main outcome was the adjusted hazard ratio for hospitalizations after one year using a Cox-proportional hazards model. Results We recruited 121 persons in each group. The crude hazard ratio for hospital admissions, comparing the intervention to the control group was 0.622 (95% CI: 0.427–0.904; p = 0.013). The adjusted hazard ratio (aHR) was 0.503 (95% CI: 0.340–0.746; p = 0.001). The aHR for death was 0.993 (95% CI: 0.492–2.002; p = 0.984). The absolute difference in the quality of life was 16.59 points (95% CI: 12.03–21.14; p < 0.001). Discussion The integration programme had lower hospital admissions and better quality of life than the usual care. There was no significant difference in death rates.
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来源期刊
CiteScore
3.10
自引率
14.30%
发文量
15
期刊介绍: The International Journal of Care Coordination (formerly published as the International Journal of Care Pathways) provides an international forum for the latest scientific research in care coordination. The Journal publishes peer-reviewed original articles which describe basic research to a multidisciplinary field as well as other broader approaches and strategies hypothesized to improve care coordination. The Journal offers insightful overviews and reflections on innovation, underlying issues, and thought provoking opinion pieces in related fields. Articles from multidisciplinary fields are welcomed from leading health care academics and policy-makers. Published articles types include original research, reviews, guidelines papers, book reviews, and news items.
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