WONCA研究论文摘要汇编——医生的连续性对心力衰竭患者出院后死亡和急诊再住院的影响

发布时间：2019-02-14 20:51

【摘要】：背景心力衰竭患者出院后,医生做早期随访与死亡和再住院率下降相关,此研究探讨了医生的连续性是否会进一步影响患者出院后的转归。方法数据源于数据库,将加拿大艾伯塔省1999年1月—2009年6月,年满20周岁首次诊断为心力衰竭的,且出院时还活着的患者纳入研究。采用协变量随时间变化的Cox比例风险模型,就患者熟悉的医生在患者出院后1个月内做随访,其对6个月内患者发生死亡或任何原因急诊再入院等主要转归的影响进行分析。患者熟悉的医生定义:患者入院前1年至少看过患者2次,或患者住院期间看过患者至少1次的医生。结果出院后1个月,24 373例患者中,有5 336例(21.9%)患者未接受过随访,16 855(69.2%)例患者接受了熟悉医生的随访,2 182(9.0%)例接受陌生医生的随访。6个月观察期内,与未接受过随访的患者(62.9%)相比,接受熟悉医生早期随访的患者〔43.6%;校正危险比(HR)=0.87,95%CI(0.83,0.91)〕或接受陌生医生早期随访的患者〔43.6%;校正HR=0.90,95%CI(0.83,0.97)〕发生死亡或非计划入院的风险性要低。将接受随访时间超过6个月的患者也纳入分析,与接受陌生医生随访相比,由熟悉医生做随访,患者发生死亡和急诊再住院的风险要低〔校正HR=0.91,95%CI(0.85,0.98)〕。解释心力衰竭患者出院后,医生的早期随访及医生的连续性,均与患者获得较好的临床转归相关。在其他疾病及其他环境下,医生的连续性是否也起到重要作用还需做进一步研究。
[Abstract]:Background early follow-up of patients with heart failure after discharge is associated with a decrease in mortality and readmission. This study was conducted to investigate whether the continuity of doctors may further affect the outcome of discharged patients. Methods data derived from the database included patients who were first diagnosed with heart failure at the age of 20 and were still alive at the time of discharge from January 1999 to June 2009 in Alberta Canada. By using the Cox proportional risk model with covariable variation over time, the main outcomes of the patients' death or readmission for any reason were analyzed during the first month after discharge from hospital by the familiar doctors. A doctor who sees a patient at least twice a year before admission, or at least once during hospitalization. Results one month after discharge, 5 336 (21. 9%) of 24 373 patients were not followed up, 16 855 (69. 2%) were followed up by familiar doctors. 2182 (9.0%) patients were followed up by strange doctors. During the 6-month observation period, compared with the patients who had not been followed up (62.9%), the patients who were familiar with the doctor's early follow-up (43.6%) were compared with those who had not been followed up (62.9%). The corrected risk was lower than the risk of death or unplanned admission in patients with (HR) = 0.87% 95 CI (0.83 卤0.91) or early follow-up by a strange doctor (43.6; adjusted HR=0.90,95%CI (0.830.97). Patients who were followed up for more than 6 months were also included in the analysis. The risk of death and readmission of emergency patients was lower than that of unfamiliar doctors (adjusted HR=0.91,95%CI (0.850.98). It was explained that the early follow-up and continuity were related to the clinical outcome of patients with heart failure. In other diseases and other settings, whether the continuity of doctors also plays an important role needs to be further studied.
【作者单位】：中国石油天然气集团公司中心医院;
【分类号】：R541.6

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