2020 年 COVID-19 期间法国全科医生对疗养院患者管理的适应性:多层次分析。

IF 2 Q2 MEDICINE, GENERAL & INTERNAL
Veronique Orcel, Tiphanie Bouchez, Aline Ramond-Roquin, Yann Bourgueil, Vincent Renard, Sylvain Gautier, Julien Le Breton
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引用次数: 0

摘要

背景:描述法国全科医生(GPs)在 COVID-19 第一波(2020 年 5 月)期间为确保疗养院患者后续护理而采取的适应策略,并确定与每种策略相关的因素:描述法国全科医生(GPs)在COVID-19第一波(2020年5月)期间确保护理院患者后续护理的适应策略,并确定与每种策略相关的因素:2020 年 5 月,我们通过在线问卷对在法国(本土和海外)执业的全科医生进行了一项全国性横断面研究,这些全科医生在大流行前通常会为养老院患者提供上门服务。研究结果被定义为全科医生管理养老院患者的适应策略,并分为四组:维持护理院出诊 NHV(参考)、停止 NHV、数字适应(仅远程会诊)、混合适应(NHV 和远程会诊)。适应策略的概率通过多级逻辑模型进行分析,其中全科医生代表一级,县代表二级。我们应用了三个随机截距多层次逻辑模型,全科医生所在县为随机效应:这项分析包括来自法国 98 个县的 2,146 名全科医生的回答。总体而言,40.4% 的全科医生坚持 NHV,其他策略包括停止就诊(24.1%)、数字调整(15.4%)、混合调整(20.1%)。一些个人因素(年龄、接受过全科医生培训、认为自己是严重 COVID 的高危人群、遵守临时委托管理病人的规定)和地区因素(COVID-19 导致的超额死亡率、全科医生的密度、75 岁以上老人的比例、是否有针对疗养院病人的强化措施)被认为与每种策略相关:本研究强调了全科医生为继续支持疗养院患者而进行的快速调整。适应策略的异质性既反映了国家指导方针的缺乏,也反映了全科医生惯常做法的异质性。政策制定者应在地区层面(次国家层面)采取行动,加强对养老院患者的支持,同时考虑适应当地大流行病爆发的背景和当地参与者的观点。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Adaptation of French general practitioners for the management of nursing home patients during COVID-19 in 2020: a multilevel analysis.

Background: To describe French general practioners' (GPs) adaptation strategies to ensure follow-up care of nursing home patients during the first wave of COVID-19 (May 2020) and to identify factors associated with each strategy.

Methods: A national cross-sectional study was conducted with online questionnaires in May 2020 among GPs practicing in France (metropolitan and overseas) and usually providing nursing home visits before pandemic. The outcome was defined as the GPs' adaptation strategies for managing nursing home patients and was categorized into four groups: Maintenance of Nursing Home Visits NHV (reference), Stopping NHV, Numeric adaptation (teleconsultations only), Mixed adaptation (NHV and teleconsultations). The probability of adaptation strategies was analyzed by multilevel logistic models in which the GPs represented level 1 and the counties level 2. We applied three random-intercept multilevel logistic models with the county of GP's practice as random effect.

Results: This analysis included 2,146 responses by GPs coming from 98 French counties. Overall, 40.4% of GPs maintained NHV, while other strategies were: Stopping visits (24.1%), Numeric adaptation (15.4%), Mixed adaptation (20.1%). Several individual (age, training GP, perceived status of being at high risk of severe COVID, compliance with temporary delegation of the patient's management) and territorial factors (excess mortality rate due to COVID-19, GPs' density, proportion of over-75s, presence of reinforcement measures for nursing home patients) were identified as associated with each strategy.

Conclusions: This study highlights a rapid adaptation of general practice to keep supporting nursing home patients. Heterogeneity of adaptation strategies could reflect both the lack of national guidelines and the heterogeneity among GPs' usual practices. Policymakers should take actions at a territorial level (subnational) to strengthen support to nursing home patients considering adaptations to the local context of the pandemic outbreak and perspective of local actors.

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