quality care

优质护理
  • 文章类型: Journal Article
    背景:随着医疗技术的不断进步,神经外科护理不断发展和完善,提供更优质的护理服务。
    目的:探讨神经外科护理中不同类型优质护理对临床护理质量及患者满意度的影响。
    方法:选择2020年6月至12月在西南医科大学附属医院接受神经外科治疗的80例患者作为研究对象,分为研究组和对照组。研究组由40名患者组成,他们接受了4种不同类型的优质护理,而对照组包括40例接受常规护理的患者。经过一段特定的时期,比较两组患者的护理满意度、不良事件及并发症发生率。
    结果:对高质量护理的满意度高于常规护理,高质量的卫生服务和区域服务表现出最高的满意度,格拉斯哥量表的平均得分为12分。研究组和对照组的满意度分别为75%和57%,分别,差异具有统计学意义(t=7.314,P<0.05)。在护理期间,III级病理分级和神经外科手术患者的不良事件和并发症发生率最高(40.02%和85.93%,分别),差异有统计学意义。
    结论:在神经外科护理中,采用适当的优质护理方法可以有效降低患者的不良事件和并发症发生率,从而提高护理质量,增加临床护理价值。
    BACKGROUND: With continuous advancements in medical technology, neurosurgical nursing is constantly developing and improving to provide higher-quality nursing services.
    OBJECTIVE: To explore the effects of different types of high-quality nursing care on clinical nursing quality and patient satisfaction in neurosurgical nursing.
    METHODS: Eighty patients who received neurosurgical treatment in the Affiliated Hospital of Southwest Medical University from June to December 2020 were selected as study participants and categorised into study and control groups. The study group comprised 40 patients who received 4 different types of high-quality nursing care, whereas the control group comprised 40 patients who received conventional nursing care. After a specific period, nursing satisfaction levels and adverse event and complication rates were compared between the two groups.
    RESULTS: Satisfaction with high-quality care was higher than that with conventional care, and high-quality health services and regional services showed the highest satisfaction levels, with an average score of 12 on the Glasgow scale. The satisfaction levels of the study and control groups were 75% and 57%, respectively, with a statistically significant difference (t = 7.314, P < 0.05). During the nursing period, the adverse event and complication rates were the highest in patients with level III pathology grade and those who underwent neurosurgery (40.02% and 85.93%, respectively), and the difference was statistically significant.
    CONCLUSIONS: In neurosurgical nursing, employing appropriate high-quality nursing methods can effectively reduce adverse event and complication rates in patients, thereby improving the quality of nursing care and increasing clinical nursing value.
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  • 文章类型: Journal Article
    目的:研究患者报告的同情经历对整体患者质量护理评级的独特贡献。此外,我们评估患者在急诊科报告的同情经历在社会人口统计学组之间是否存在差异。
    方法:这项横断面研究的省级数据是从2022年3月1日至2022年9月5日从艾伯塔省的14个急诊科收集的,加拿大。来自4501名急诊科患者的数据(53.6%为女性,77.1%白色/欧洲)进行分析。主要结果是患者在最近一次ED访视期间的总体质量护理评级。分层逐步回归中包括的措施包括人口统计,以及从急诊科患者护理体验(EDPEC)问卷中提取的数据:患者信息的单项和多项测量(例如,患者感知健康)和患者体验(例如,医师沟通),和同情心(例如,辛克莱同情问卷;SCQ-ED)。
    结果:分析了4501例ED患者的数据。逐步分层线性多元回归表明,在21个包含变量中,同情心最强烈地预测总体质量护理评级(b=1.61,95%CI1.53-1.69,p<.001,f2=.23),解释了超过所有其他衡量标准的19%的独特差异。单向方差分析表明,平均同情心得分存在显著的人口统计学差异,这样女人(vs.男性)报告较低的同情心(MD=-.15,95%CI=-.21,-.09,p<.001),和土著(vs.白人)患者的同情心较低(MD=-.17,95%CI=-.34,-.01,p=.03)。
    结论:同情心被认为是ED整体质量护理评级的关键贡献者,同情的经历随着人口统计学的变化而变化。患者报告的同情心是质量护理的指标,需要正式纳入临床护理和质量护理评估。
    OBJECTIVE: To examine the unique contribution of patient reported experiences of compassion to overall patient quality care ratings. Additionally, we assess whether patients\' reported experiences of compassion in the emergency department differed between sociodemographic groups.
    METHODS: Provincial data for this cross-sectional study were collected from 03/01/2022 to 09/05/2022 from 14 emergency departments in Alberta, Canada. Data from 4501 emergency department patients (53.6% women, 77.1% White/European) were analyzed. The primary outcome was patients\' overall quality care ratings during their most recent ED visit. Measures included in the hierarchical stepwise regression included demographics, and those drawn from the Emergency Department Patient Experience of Care (EDPEC) questionnaire: single and multi-item measures of patient information (e.g., patient perceptions health) and patient experience (e.g., physician communication), and compassion (e.g., Sinclair Compassion Questionnaire; SCQ-ED).
    RESULTS: Data from 4501 ED patients were analysed. Stepwise hierarchical linear multiple regression indicated that of 21 included variables, compassion most strongly predicted overall quality care ratings (b=1.61, 95% CI 1.53-1.69, p<.001, f2=.23), explaining 19% unique variance beyond all other measures. One-way ANOVAs indicated significant demographic differences in mean compassion scores, such that women (vs. men) reported lower compassion (MD=-.15, 95% CI=-.21, -.09, p<.001), and Indigenous (vs. White) patients reported lower compassion (MD=-.17, 95% CI =-.34, -.01, p=.03).
    CONCLUSIONS: Compassion was identified as a key contributor to ED overall quality care ratings, and experiences of compassion varied as a function of demographics. Patient-reported compassion is an indicator of quality care that needs to be formally integrated into clinical care and quality care assessments.
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  • 文章类型: Case Reports
    子宫平滑肌瘤(ULs)是常见的良性肿瘤,在很大一部分女性中可以根据其在子宫内的位置进行分类。它们可以引起许多骨盆并发症,并且可以进行医学管理,但更常见的是手术。子宫肌瘤常发生在产后,可能是梗塞,并可能导致变性和败血症。我们的病人出现了两个月的潜在化脓性肌瘤,最初在计算机断层扫描(CT)上发现。办公室检查显示子宫颈有突出的肿块,并尝试切除,但最终因疼痛而推迟进行全身麻醉检查。切除平滑肌瘤并显示坏死。化脓性肌瘤通常是阴险的,并且通常可以模仿其他有关的病理。现代成像可以显示骨盆内的病变,但难以在液体收集和可能的梗塞肿块之间进行确定。在这种情况下,质量护理措施的重要性值得强调,以防止严重的并发症。
    Uterine leiomyomas (ULs) are common benign tumors seen in a large percent of women that can be classified based on their location within the uterus. They can cause a number of pelvic complications and can be managed medically, but more often surgically. Uterine pyomyomas often occur postpartum, possibly from infarction, and can lead to degeneration and sepsis. Our patient presents with a two-month development of a potential pyomyoma, found initially on computed tomography (CT). Office exam reveals a protruding mass from the cervical os, and removal was attempted but ultimately postponed for general anesthesia exam due to pain. The leiomyoma was removed and shown to be necrosing. Pyomyomas are often insidious and can often mimic other concerning pathologies. Modern imaging can show lesions within the pelvis but struggle to determine between fluid collection and possible infarcted masses. The importance of quality care measures in cases like this deserve to be emphasized to prevent serious complications.
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  • 文章类型: Journal Article
    医疗机构提供的医疗保健应优先考虑家庭的需求,因为它提高了患者的护理质量。家庭满意度衡量医疗保健专业人员如何有效地解决家庭成员的感知需求和期望。众多因素,包括信息传播,通信,家庭动态,患者特征,医院设施,和护理过程,作为家庭满意度的预测因子。因此,这项研究旨在评估入住重症监护病房的患者家属对所接受护理的满意度。
    从2023年3月至6月,在多个中心进行了一项基于医院的横断面研究,涉及400名参与者。通过检查方差膨胀因子(VIF)来评估多重共线性,而拟合优度使用Hosmer和Lemeshow检验进行评估。使用双变量和多变量逻辑回归分析来确定与家庭满意度相关的因素。双变量逻辑回归中p值低于0.2的变量包括在多变量逻辑回归分析中。计算具有95%置信区间的调整后的赔率比(AOR)以指示关联强度。在多变量分析中,p值小于0.05的变量被认为具有统计学意义.
    家庭对重症监护室提供的护理的总体满意度为58.6%,95%置信区间为55.882%至61.241%。家庭对患者护理(64.8%)和专业护理(67.4%)的满意度较高。然而,他们报告说,对家庭提供的护理的满意度较低(52.2%),ICU环境(56.8%),家庭参与决策(55.8%)。缺乏正规教育(AOR:1.949,95%CI:1.005,4.169),完成初等教育(AOR:2.581,95%CI:1.327,5.021),并且完成9-12级(AOR:2.644,95%CI:1.411,4.952)与家庭总体满意度显著相关.
    总体满意度令人满意。为了提高服务质量和家庭满意度,医疗保健提供者应优先考虑与家庭成员进行有效和定期的沟通。让他们充分了解患者的病情和治疗计划至关重要。
    UNASSIGNED: Healthcare provided in medical facilities should prioritize the needs of families, as it enhances the quality of care for the patients. Family satisfaction gauges how effectively healthcare professionals address the perceived needs and expectations of family members. Numerous factors, including information dissemination, communication, family dynamics, patient characteristics, hospital facilities, and the caregiving process, serve as predictors of family satisfaction. Thus, this study seeks to evaluate the satisfaction of families with the care received by patients admitted to the intensive care unit.
    UNASSIGNED: A hospital-based cross-sectional study involving 400 participants was conducted across multiple centers from March to June 2023. Multicollinearity was assessed by examining variance inflation factors (VIF), while the goodness-of-fit was evaluated using the Hosmer and Lemeshow test. Both bivariable and multivariable logistic regression analyses were utilized to identify factors correlated with family satisfaction. Variables with a p-value below 0.2 in the bivariable logistic regression were included in the multivariable logistic regression analysis. Adjusted Odds Ratios (AORs) with 95% Confidence Intervals were computed to indicate the strength of association. In the multivariable analysis, variables with a p-value less than 0.05 were deemed statistically significant.
    UNASSIGNED: The overall family satisfaction with the care provided in the intensive care unit was 58.6%, with a 95% confidence interval ranging from 55.882% to 61.241%. Families expressed higher satisfaction levels with patient care (64.8%) and professional care (67.4%). However, they reported lower satisfaction levels regarding care provided for families (52.2%), the ICU environment (56.8%), and involvement of families in decision-making (55.8%). Lack of formal education (AOR: 1.949, 95% CI: 1.005, 4.169), completion of primary education (AOR: 2.581, 95% CI: 1.327, 5.021), and completion of grades 9-12 (AOR: 2.644, 95% CI: 1.411, 4.952) were found to be significantly associated with overall family satisfaction.
    UNASSIGNED: The overall level of satisfaction is satisfactory. To enhance service quality and family satisfaction, healthcare providers should prioritize effective and regular communication with family members. Keeping them well informed about the patient\'s condition and treatment plan is essential.
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  • 文章类型: Meta-Analysis
    系统评价优质护理对烧伤患者创面疼痛和焦虑的影响。PubMed的电脑搜索,谷歌学者,科克伦图书馆,Embase,万方,从数据库开始到2023年10月,对中国生物医学文献数据库和中国国家知识基础设施数据库进行了关于优质护理在烧伤患者中应用的随机对照试验(RCT)。根据纳入和排除标准,由两名研究人员筛选和评估文献。并从最终纳入的文献中提取数据。采用Stata17.0软件进行数据分析。总的来说,包括15例RCT和1115例烧伤患者,包括优质护理和常规护理组的563和552。结果发现,与常规护理相比,实施优质护理的烧伤患者伤口疼痛明显减轻(SMD:-1.79,95%CI:-2.22至-1.36,p<0.001),焦虑(SMD:-2.71。95%CI:-3.49至-1.92,p<0.001)和抑郁(SMD:-1.74,95%CI:-2.35至-1.14,p<0.001)水平在创伤后明显降低。
    To systematically evaluate the effects of quality nursing care on wound pain and anxiety in burn patients. Computerised searches of PubMed, Google Scholar, Cochrane Library, Embase, Wanfang, China Biomedical Literature Database and China National Knowledge Infrastructure databases randomised controlled trials (RCTs) on the application of quality nursing care to burn patients were carried out from database inception to October 2023. Literature was screened and evaluated by two researchers based on inclusion and exclusion criteria, and data were extracted from the final included literature. Stata 17.0 software was employed for data analysis. Overall, 15 RCTs and 1115 burn patients were included, including 563 and 552 in the quality care and routine care groups. It was found that, compared with routine care, burn patients who implemented quality care had significantly less wound pain (SMD: -1.79, 95% CI: -2.22 to -1.36, p < 0.001), anxiety (SMD: -2.71. 95% CI: -3.49 to -1.92, p < 0.001) and depression (SMD: -1.74, 95% CI: -2.35 to -1.14, p < 0.001) levels were significantly reduced post-trauma.
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  • 文章类型: Journal Article
    BACKGROUND: Maternal and child malnutrition represents a public health problem in Mexico Primary care (PC) is responsible for introducing women and children under five to the health system, detecting diseases on time, and providing medical services, including pharmacological treatment if necessary. Providing these services with quality is essential to improve maternal and child health. This study evaluated the quality of nutritional care during preconception, pregnancy, postpartum, infancy, and preschool age at the PC health units across six Mexican states between 2020 and 2021.
    METHODS: We conducted a cross-sectional study with a mixed approach in units of the Secretary of Health to assess the quality of nutritional care during preconception, pregnancy, postpartum, childhood, and preschool age. The level of quality was calculated by the percentage of compliance with 16 indicators that integrated a Quality Index of Maternal and Child Nutritional Care (ICANMI, by its Spanish acronym). Compliance by indicator, by life stage, and overall was categorized using the following cut-off points: poor quality (≤ 70%), insufficient quality (71-89%), and good quality (≥ 90%). The perceptions of the barriers and facilitators that affect maternal and child nutrition were evaluated through semi-structured interviews with health professionals (HP) and users. All qualitative instruments were developed with a gender and intercultural perspective.
    RESULTS: Considering the whole sample studied, maternal and child nutritional care quality during the five life stages evaluated was bad (compliance: ≤12%), reflected in the ICANMI, which had a compliance of 8.3%. Principal barriers identified to providing high-quality nutritional care were the lack of knowledge and training of health professionals, shortages of equipment, medicine, personnel, and materials, the disappearance of the social cash transfer program Prospera, the absence of local indigenous language translators to support communication between doctor and patient, and the persistence of machismo and other practices of control over women.
    CONCLUSIONS: These findings underscore the need for initiatives to improve the quality of nutritional care in PC facilities across Chihuahua, State of Mexico, Veracruz, Oaxaca, Chiapas, and Yucatan. It is necessary for government and health authorities, along with various stakeholders, to collaboratively devise, implement, and assess intercultural and gender-oriented policies and programs geared towards ensuring the health infrastructure and enhancing the training of health professionals to diagnose and treat the prevalence and occurrence of diverse forms of malnutrition in both maternal and child populations.
    RESULTS: ANTECEDENTES: La mala nutrición materno-infantil (MMI) representa un problema de salud pública en México. El primer nivel tiene la respondabilidad de introducir a mujeres y niños menores de 5 años al sistema de salud, detectar oportunamente las enfermedades y brindar servicios médicos incluido el farmacológico de ser necesario. Prestar estos servicios con calidad resulta elemental para mejorar la salud de la población materno-infantil. El objetivo de este estudio fue evaluar la calidad de la atención nutricional durante las etapas de preconcepción, embarazo, posparto, infancia y edad preescolar en centros de salud de seis estados de México entre 2020 y 2021. MéTODOS: Se realizó un estudio transversal con metodología mixta en 95 centros de salud la Secretaría de Salud de México para evaluar la calidad de la atención nutricional durante la preconcepción, el embarazo, el posparto, la infancia y la etapa preescolar. El nivel de calidad se calculó mediante el porcentaje de cumplimiento de 16 indicadores que a su vez integraron un Índice de Calidad de la Atención Nutricional Materno Infantil (ICANMI). El cumplimiento por indicador, etapa de vida y global fue categorizado utilizando los siguientes puntos de corte: mala calidad (≤ 70%), calidad insuficiente (71-89%) y buena calidad (≥ 90%). La percepción sobre las barreras y facilitadores que afectan la atención nutricional materno-infantil fueron identificadas a través de entrevistas semiestructuradas y grupos focales realizadas a profesionales de salud, usuarias y usuarios. Todos los instrumentos cualitativos fueron desarrollados con un enfoque de género e interculturalidad.
    RESULTS: La calidad de la atención nutricional materno infantil durante las cinco etapas de la vida evaluadas fue mala (cumplimiento: ≤12%), mientras que el ICANMI tuvo un cumplimiento de 8.3%. Las principales barreras identificadas para brindar una atención nutricional de alta calidad fueron la falta de conocimiento y capacitación de los profesionales de la salud, la escasez de equipos, medicamentos, personal y materiales, la desaparición del programa social de transferencias monetarias Prospera, la ausencia de una lengua indígena local, entre otros. Así como la persistencia de prácticas como el machismo y otras de control sobre las mujeres.
    CONCLUSIONS: Estos hallazgos subrayan la necesidad inmediata de implementar iniciativas que mejoren el estándar de atención nutricional en los centros de salud en Chihuahua, Estado de México, Veracruz, Oaxaca, Chiapas y Yucatán. Es necesario que el gobierno y las autoridades sanitarias, junto con diversas partes interesadas, diseñen, implementen y evalúen en colaboración políticas y programas orientados a mejorar la calidad de la atención nutricional, con perspectiva de género e interculturalidad. Este esfuerzo tiene como objetivo mitigar la prevalencia y aparición de diversas formas de desnutrición tanto en la población materna como infantil.
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  • 文章类型: Journal Article
    全面的高质量护理对于预防糖尿病并发症和提高生活质量至关重要。这需要遵守指南和集中治疗。埃塞俄比亚没有使用标准指南(美国糖尿病协会和国际糖尿病联合会)作为参考来评估糖尿病护理质量的数据。
    在Yekatit12医院医学院(YHMC)进行了一项横断面研究,以评估糖尿病患者的过程和结果质量指标。数据是在2022年5月至7月期间从门诊诊所收集的,为期3个月。使用系统随机抽样选择自诊断以来至少一年的糖尿病患者。测量了糖尿病优质护理指标的过程和结果,并与标准指南(ADA和IDF)进行了比较。采用描述性统计和逻辑回归进行数据分析。P值<0.05为统计学意义。
    纳入了约250名平均年龄为53±15岁的糖尿病患者。大多数为2型糖尿病(83.2%)。128例(51.2%)患者的HbA1c测定,近期平均值为8±1.6。只有52例(40.6%)患者达到了目标HbA1c。年度全面足部检查,尿蛋白试验,视网膜检查54例(21.6%),52(20.8%),和122(48.8%),分别。单身婚姻状况(AOR=5.76;95%CI;1.02-32.36)P=0.047,每年至少确定两次HbA1c水平(AOR=6.27;95%CI;2.18-17.73)P=0.001,服药依从性(AOR=7.1;95%CI;2.61-19.01)P=0.001,与良好的血糖控制显着相关。
    发现糖尿病护理的总体质量在过程和结果质量指标上均不理想。因此,对护理人员质量指标的认识创造,遵守准则,明智的资源利用,以及与医院管理团队等不同利益相关者的合作,需要政府官员。
    UNASSIGNED: Comprehensive high quality of care is critical in preventing diabetic complications and improving quality of life. This needs compliance with guidelines and focused therapy. There is no data in Ethiopia evaluating the quality of diabetes care using standard guidelines (American diabetic association and international diabetic federation) as a reference.
    UNASSIGNED: A cross-sectional study was conducted at Yekatit 12 Hospital Medical College (YHMC) to assess the process and outcome quality indicators of diabetic patients. Data were collected from outpatient clinics between May and July 2022 over a period of 3 months. Diabetic patients with at least one year since diagnosis were selected using systematic random sampling. Both the process and outcome of diabetic quality care indicators were measured and compared with standard guidelines (ADA and IDF). Both descriptive statistics and logistic regression were used for data analysis. The P-value <0.05 was used as statistical significance.
    UNASSIGNED: About 250 diabetic patients with a mean age of 53±15 were included. The majority were type 2 diabetes mellitus (83.2%). HbA1c was determined for 128 (51.2%) patients with the recent mean value of 8±1.6. Only 52 (40.6%) of patients achieved target HbA1c. Annual comprehensive feet examination, urine albuminuria test, and retinal examination were done for 54 (21.6%), 52 (20.8%), and 122 (48.8%), respectively. Single marital status (AOR = 5.76; 95% CI; 1.02-32.36) P = 0.047, determining HbA1c level at least twice a year (AOR = 6.27; 95% CI; 2.18-17.73) P = 0.001, and medication adherence (AOR = 7.1; 95% CI; 2.61-19.01)P = 0.001, were significantly associated with good glycemic control.
    UNASSIGNED: The overall quality of diabetic care was found suboptimal both in process and outcome quality indicators. Thus, awareness creation about quality indicators for caregivers, compliance with guidelines, wise resource utilization, and cooperation with different stakeholders like hospital management teams, and government officials is needed.
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  • 文章类型: Journal Article
    背景:老年癌症患者及其家庭成员的独特生活状况要求医疗保健专业人员采取整体方法来实现优质护理。这项研究的目的是评估老年癌症患者和家庭成员对所接受护理质量的看法,并评估他们看法之间的差异。进一步的目的是检查哪些因素可以解释患者和家庭成员对所接受护理的满意度。
    方法:本研究是描述性和横断面设计。数据来自癌症医院四个病房的患者(n=81)及其家庭成员(n=65),使用修订的人道关怀量表(RHCS)。数据采用描述性统计分析,交叉,Wilcoxon符号秩检验,和多变量协方差分析(ANCOVA)。
    结果:家庭成员对护理质量的负面看法比患者更多。不满意与专业实践有关(p<0.001),患者和医疗保健专业人员之间的互动(p<0.001),对身体需求的认知(p=0.024),和人力资源(p<0.001)。对整体护理的满意度在那些患者和家庭成员中明显较低,他们认为他们没有参与为患者的护理制定明确的目标(p=0.002)。
    结论:重要的是,老年癌症患者和家庭成员接受友好的治疗,尊敬的,基于他们的需求和希望的个人护理,他们可以依靠专业人士。医疗保健专业人员需要更多的资源和教育来照顾老年癌症患者,以提供优质的护理。
    BACKGROUND: The unique life situations of older patients with cancer and their family members requires that health care professionals take a holistic approach to achieve quality care. The aim of this study was to assess the perceptions of older patients with cancer and family members about the quality of care received and evaluate differences between their perceptions. A further aim was to examine which factors explain patients\' and family members\' levels of satisfaction with the care received.
    METHODS: The study was descriptive and cross-sectional in design. Data were collected from patients (n = 81) and their family members (n = 65) on four wards in a cancer hospital, using the Revised Humane Caring Scale (RHCS). Data were analysed using descriptive statistics, crosstabulation, Wilcoxon signed rank test, and multivariable Analysis of Covariance (ANCOVA).
    RESULTS: Family members had more negative perceptions of the quality of care than patients did. Dissatisfaction was related to professional practice (p < 0.001), interaction between patient and health care professionals (p < 0.001), cognition of physical needs (p = 0.024), and human resources (p < 0.001). Satisfaction with overall care was significantly lower among those patients and family members who perceived that they had not been involved in setting clear goals for the patient\'s care with staff (p = 0.002).
    CONCLUSIONS: It is important that older patients with cancer and family members receive friendly, respectful, individual care based on their needs and hopes, and that they can rely on professionals. Health care professionals need more resources and education about caring for older cancer patients to provide quality care.
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  • 文章类型: Journal Article
    医疗保健中的质量护理是一个多方面的概念,包括执行有效的医疗和患者的整体体验。它涉及多种因素,包括有效性,安全,及时性、及时性股本,和病人中心,这对塑造医疗保健格局很重要。这项横断面研究使用了健康信息国家趋势调查6(HINTS6)的数据,收集有关健康沟通和信息寻求行为各个方面的数据,调查与白人和西班牙裔人群优质护理相关的因素。所有参加HINTS6并在过去12个月内至少访问过一次医疗保健服务的成年人都被纳入本研究。多变量逻辑回归用于确定优质护理与延迟或有区别的护理之间的关联,并调整所有其他社会人口统计学变量。我们共分析了3611名参与者。健康的不良社会决定因素(SDOHs)(OR0.61,CI0.43-0.88,p=0.008),延迟需要的医疗护理(OR0.34,CI0.26-0.43,p<0.001),和有区别的护理(OR0.29,CI0.15-0.54,p<0.001)均与最佳质量护理呈负相关。阴性SDOH也可能与延迟护理和歧视性护理呈正相关。
    Quality care in healthcare is a multifaceted concept that encompasses the execution of effective medical treatments and the patient\'s overall experience. It involves a multitude of factors, including effectiveness, safety, timeliness, equity, and patient centeredness, which are important in shaping the healthcare landscape. This cross-sectional study used the data from the Health Information National Trends Survey 6 (HINTS 6), which collects data on various aspects of health communication and information-seeking behaviors, to investigate the factors associated with quality care among White and Hispanic populations. All adults who participated in HINTS 6 and visited healthcare service at least once in the past 12 months were included in this study. Multivariable logistic regression was used to determine the association between quality care and delay or discriminated care with the adjustment of all other sociodemographic variables. We analyzed a total of 3611 participants. Poor social determinants of health (SDOHs) (OR 0.61, CI 0.43-0.88, p = 0.008), delayed needed medical care (OR 0.34, CI 0.26-0.43, p < 0.001), and discriminated care (OR 0.29, CI 0.15-0.54, p < 0.001) were all negatively associated with optimal quality care. Negative SDOHs could also be positively associated with delayed care and discriminated care.
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  • 文章类型: Journal Article
    背景:HIV感染者(PLWH)患糖尿病和高血压的风险更高。艾滋病毒和非传染性疾病的服务通常是分开的,但这如何影响PLWH中的非传染性疾病护理尚不清楚。我们旨在了解预防的障碍和促进者,PLWH对糖尿病和高血压的早期诊断和安全有效的护理。
    方法:对10名护理PLWH的医疗保健专业人员(HCPs)进行了半结构化访谈(SSIs),10个为糖尿病和高血压患者提供护理的HCP和16个患有糖尿病和/或高血压的PLWH。参与者是从多多马的两个医疗机构招募的,坦桑尼亚和有目的地根据年龄和性别采样。采访是在斯瓦希里语使用预先制定的主题指南进行的,录音然后逐字翻译成英语。使用框架方法进行了归纳主题分析。
    结果:发现了三个主题:组织/医疗保健系统因素,个体因素和共病因素。组织/医疗保健系统因素包括唯一的预防促进者(关于生活方式行为的教育和关于依从性的咨询),但包括了最多的障碍:分散的服务,无NCD筛查方案和无法获得诊断设备是早期诊断的障碍,而前者加上缺乏NCD护理的连续性是安全有效护理的障碍.个别因素包括四个子主题,其中三个被认为是促进者:HCPs对非传染性疾病的早期诊断知识,非传染性疾病的自我监测,以实现安全有效的护理,并为早期诊断和安全有效的护理提供个人实践。HCPs知识是预防的障碍,而PLWH知识是预防和安全有效护理的障碍。综合因素包括三个子主题;都是预防的障碍,早期诊断和/或安全有效的护理:PLWH和HIV污名的贫困和心理健康。
    结论:组织/医疗保健系统,发现个人和联合因素与有助于预防的障碍和促进因素相互关联,坦桑尼亚PLWH中糖尿病和高血压的早期诊断和安全有效的护理;这些发现可以为未来的举措提供信息,以改变小型和大型卫生系统,改善老龄化PLWH的健康。
    People living with HIV (PLWH) are at a higher risk for developing diabetes and hypertension. Often services are separate for HIV and non-communicable diseases (NCDs), but how this impacts NCD care among PLWH is unknown. We aimed to understand the barriers and facilitators for prevention, early diagnosis and safe effective care for diabetes and hypertension among PLWH.
    Semi-structured interviews (SSIs) were conducted with 10 healthcare professionals (HCPs) that care for PLWH, 10 HCPs that care for people with diabetes and hypertension and 16 PLWH with a comorbidity of diabetes and/or hypertension. Participants were recruited from two healthcare facilities in Dodoma, Tanzania and purposively sampled based on age and sex. Interviews were conducted in Swahili using pre-developed topic guides, audio recorded then translated verbatim into English. An inductive thematic analysis was conducted using The Framework Method.
    Three themes were found: organisational/healthcare system factors, individual factors and syndemic factors. Organisational/healthcare system factors comprised the only facilitators for prevention (education on lifestyle behaviours and counselling on adherence), but included the most barriers overall: fragmented services, no protocol for NCD screening and lack of access to diagnostic equipment were barriers for early diagnosis whereas the former plus lack of continuity of NCD care were barriers for safe effective care. Individual factors comprised four sub-themes, three of which were considered facilitators: HCPs\' knowledge of NCDs for early diagnosis, self-monitoring of NCDs for safe effective care and HCPs\' personal practice for both early diagnosis and safe effective care. HCPs\' knowledge was simultaneously a barrier for prevention and PLWH knowledge was a barrier for prevention and safe effective care. Syndemic factors comprised three sub-themes; all were barriers for prevention, early diagnosis and/or safe effective care: poverty and mental health of PLWH and HIV stigma.
    Organisational/healthcare system, individual and syndemic factors were found to be interlinked with barriers and facilitators that contribute to the prevention, early diagnosis and safe effective care of diabetes and hypertension among PLWH in Tanzania; these findings can inform future initiatives for making small and large health system changes to improve the health of aging PLWH.
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