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背景尽管连续性服务在基层医疗中是被广泛接受的核心原则,但是关于其优势的证据仍然不足。目的探讨全科医学中连续性服务是否与老年人长寿相关。设计与场所数据来源于阿姆斯特丹纵向衰老研究,对荷兰老年人进行不间断队列研究。研究样本包括1 712例年龄≥60岁的老年人,进行3年随访,周期长达17年,随访其死亡率直至2013年。方法连续性服务被定义为患者和全科医生之间不间断的治疗关系的持续过程。采用赫芬达尔-赫希曼指数计算服务的连续性(COC)。COC指数为1代表最大连续性。将COC指数<1的患者分为3组,COC最大值的参与者为第4组。采用Cox回归分析探讨COC和存活时间之间的关联。结果 742例参与者(43.3%)COC取得最大值。在生存17年的759例参与者中,251例(33.1%)仍有相同的全科医生服务。COC最小值组(指数>0~0.500)死亡率高于COC最大值组,差异有统计学意义〔HR=1.20,95%CI(1.01,1.42)〕。目前无混杂因素影响该HR。结论该研究表明全科医学中低连续性服务与高死亡风险相关,应强化该案例以鼓励连续性服务。
Background Although continuity services are a core principle that is widely accepted in primary care, there is still insufficient evidence of its advantages. Objective To investigate if continuity of care in general practice is associated with longevity in the elderly. Design and site data are sourced from longitudinal aging studies in Amsterdam and conducted on an ongoing cohort of elderly people in the Netherlands. The study sample included 1 712 elderly people aged 60 years or older who were followed up for 3 years for a period of up to 17 years. The mortality rate was followed until 2013. Methods Continuity Services are defined as a continuous process of ongoing treatment of patients and general practitioners. Service Continuity (COC) is calculated using the Herfindahl-Hirschman Index. A COC index of 1 indicates maximum continuity. Patients with a COC index <1 were assigned to three groups with a maximum COC participation of group four. Cox regression analysis was used to investigate the association between COC and survival time. Results 742 participants (43.3%) achieved the highest COC. Of the 759 participants who survived 17 years, 251 (33.1%) still had the same general practitioner service. The mortality of COC minimum group (index> 0 ~ 0.500) was higher than that of COC maximum group (HR = 1.20,95% CI (1.01,1.42)]. There are currently no confounding factors affecting the HR. Conclusions This study shows that low continuity of care in general practice is associated with a high risk of death and should be reinforced to encourage continuity of care.