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目的基于电话及互联网的沟通在基层医疗中的应用越来越普遍,而这些沟通形式对亲临诊室就诊的需求有怎样的影响还不确定。本研究评估免费安全信息和电话咨询与糖尿病患者的诊室就诊是否相关。方法研究应用断续时间系列设计并以病人-季度为单位进行分析。间接数据来自2008—2011年,在一个完整卫生保健服务体系中的以病人为中心的医疗之家(PCMH)改革的前、中及后3个时期。本研究采用线性回归模型,对基层医疗诊室就诊比例变化与安全信息和电话咨询比例增加的相关性进行估算。结果研究纳入18486例成年糖尿病患者。PCMH实施后,平均季度基层医疗接触次数较实施前(基线)增加了28%,很大程度是因为安全信息的增加;季度诊室就诊下降了8%。校正回归分析显示,安全信息及电话咨询10%的增长,分别与诊室就诊1.25%〔95%CI(1.21%,1.29%)〕和2.74%〔95%CI(2.70%,2.77%)〕的增长相关。在交互模式中,安全信息和电话咨询在所有研究时期和患者亚群的增长还是与诊室就诊增加相关(P<0.001)。结论医疗之家改革前后,糖尿病患者基层医疗诊室就诊增加与安全信息和电话咨询增加相关。我们的发现为医患沟通的新形式是如何影响诊室就诊的需求提供了证据。
PURPOSE Telephone and Internet-based communication is becoming more commonplace in primary care and its implications for the needs of visiting clinics are uncertain. This study assesses whether free safety information and telephone counseling are relevant to clinics in diabetic patients. METHODS: The study was designed using a series of intermittent time series and analyzed on a patient-by-quarter basis. Indirect data come from 2008-2011, before, during and after the PCMH reform in a complete health care delivery system. In this study, a linear regression model was used to estimate the correlation between changes in the proportion of visits to primary care clinics and the increase in the proportion of safety information and telephone counseling. Results The study enrolled 18,486 adults with diabetes. After the implementation of PCMH, the average number of quarterly primary medical contact increased 28% over the pre-implementation (baseline), largely due to the increase in safety information and a decrease of 8% in quarterly clinic attendance. Correctional regression analysis showed that the 10% increase in safety information and telephone counseling was associated with the increase of 1.25% [95% CI (1.21%, 1.29%)] and 2.74% [95% CI (2.70%, 2.77%)] Related. In the interactive mode, safety information and telephone counseling were associated with increased office visits during all study periods and patient subgroups (P <0.001). Conclusion Before and after the reform of the medical home, the increase in visits to primary care clinics in patients with diabetes was associated with an increase in safety information and telephone counseling. Our findings provide evidence of how the new forms of doctor-patient communication affect the needs of clinic visits.