Importance of relationships with primary care. Implications for patients and health care.
Notice bibliographique
Résumé
Background: Primary care is an essential part of all health care systems, constituting complex networks of relationships.If choice of primary care provider, i.e. active listing is allowed this could be linked to the strength of the relations between patients and primary care.Other aspects of these relationships could be measured using number of consultations.Primary care could be described as a healthcare system, with hospitalisation as an outcome.Objectives: The first aim of this thesis was to describe active listing and the associations with age, sex, multimorbidity, consultations, socioeconomic status and location.The second aim was to study whether relationships between patients and primary care are associated with hospitalisation, when adding patient complexity and investigating differences in performance within primary care.Methods: Cross-sectional population studies in a small Swedish county with 151 731 inhabitants in 2007.Data were collected from patient records, merged with data from Statistics Sweden in Papers II and IV.Active listing was the outcome of logistic regression models in Papers I-II.Hospitalisation, i.e. risk of hospital admission and mean hospital days, was the outcome of zero-inflated negative binomial regression models adjusted for multimorbidity, age and sex in Papers III-IV.Hospitalisation was analysed as an outcome of primary care investigating associations with active listing and number of consultations in primary care.Paper III also investigated psychiatric disorders, and Paper IV also investigated socioeconomic factors and differences in primary care.Results: The results of Paper I showed that number of consultations, multimorbidity level, age and sex were associated with active listing, and that data from primary care explained more of active listing than data from all health care.Paper II showed that multimorbidity, age, geographical location and primary care explained more of active listing than socioeconomic factors and distances to health care.Papers III-IV showed that patients actively listed or with more than one consultation were hospitalised for less than mean (0.9) days while patients passively listed or with 0-1 consultation were hospitalised for more than mean.Paper III showed that in RUB 3, moderate need for care, patients actively listed were in mean hospitalised for 3.45 (95%CI 2.84-4.07)days, if diagnosed with any psychiatric disorder and 1.64 (95%CI 1.50-1.77)days if not.Patients passively listed in RUB 3 were in mean hospitalised for 5.17 (95%CI 4.36-5.98)days, if diagnosed with any psychiatric disorder and 2.41 (95%CI 2.22-2.60)if not.Paper IV established differences within primary care comparing two types of primary care practices.Odds off hospital admission differed 49% and mean days hospitalised 0.24 days.Conclusions: Active listing in primary care is explained more by multimorbidity, age, sex and factors in local society and health care, than socioeconomic status and distances to health care.Good relationships with primary care are associated with less hospitalisation, more so when health care handles more complex multimorbidity, like including psychiatric disorders.Differences in primary care imply that management of primary care could affect hospitalisation.
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Comment cette classification a été obtenuedéplier
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Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,015 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,013 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».