减少门诊和社区卫生机构候诊时间的服务水平干预措施可能会持续:一项系统评价。

IF 1.3 Q4 HEALTH CARE SCIENCES & SERVICES
Kim Manderson, Nicholas F Taylor, Annie Lewis, Katherine E Harding
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引用次数: 0

摘要

目的:本文献系统回顾的主要目的是确定减少门诊和社区卫生服务等待时间的干预措施是否可以持续。第二个目的是描述可持续性和等待时间干预措施的特征之间的联系以及实施这些措施的环境。方法:结合“候诊时间或候诊名单”、“门诊或社区护理”、“可持续性”等概念,对CINAHL、Medline、Embase和Psych Info数据库进行检索。如果研究测试了旨在减少门诊或社区等待的服务水平干预措施,并报告了至少12个月随访期的数据,则纳入研究。数据提取和分析使用描述性综合。采用混合方法评价工具(MMAT)评价方法学质量。根据预先确定的标准,将等待干预措施分为持续、部分持续或不持续。采用推荐、评估、发展和评价的分级来描述不同干预方法的证据确定性。结果:筛选了7770项研究,产生了22篇论文,调查了大约15万名客户的等待干预措施的可持续性。许多人的质量较差,有14人不符合MMAT清单上5项标准中的3项以上。干预类型分为转诊条目、开放获取和替代,单独使用或联合使用。有低确定性证据表明,所有干预措施都与等待时间的持续减少有关,通常具有较大的效应量,但研究结果受到许多研究方法质量低和发表偏倚风险的限制。结论:在采取干预措施后,可以实现并持续减少卫生服务的等待时间和等待名单,但进一步的高质量研究将更好地告知服务提供者哪些干预措施最有效,并提供最大的投资回报。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Service-level interventions to reduce waiting time in outpatient and community health settings may be sustained: a systematic review.

Aim: The primary aim of this systematic review of the literature was to determine whether interventions to reduce waiting time in outpatient and community health services can be sustained. The secondary aim was to describe associations between sustainability and features of waiting time interventions and the settings in which they have been implemented.

Methods: CINAHL, Medline, Embase and Psych Info databases were searched, combining the search concepts 'waiting time or waiting lists', 'outpatient or community care' and 'sustainability'. Studies were included if they tested a service-level intervention that aimed to reduce waiting in an outpatient or community setting and reported data with a minimum 12-month follow-up period. Data were extracted and analysed using a descriptive synthesis. Methodological quality was evaluated using the mixed-methods appraisal tool (MMAT). Waiting interventions were rated as sustained, partially sustained or not sustained using predetermined criteria. The Grading of Recommendation, Assessment, Development and Evaluation was used to describe certainty of evidence for different intervention approaches.

Results: Screening of 7770 studies yielded 22 papers investigating the sustainability of waiting interventions for approximately 150 000 clients. Many were of lesser quality, with 14 not meeting more than 3 of 5 criteria on the MMAT checklist. Intervention types were categorised as referral entry, open access and substitution, used either alone or in combination. There was low certainty evidence that all interventions were associated with sustained reductions in waiting time, often with large effect sizes, but the findings are limited by low methodological quality of many studies and the risk of publication bias.

Conclusion: Reductions in wait times and waiting lists for health services can be achieved and sustained following interventions, but further high-quality research would better inform service providers about what interventions are most effective and provide the greatest return on investment.

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来源期刊
BMJ Open Quality
BMJ Open Quality Nursing-Leadership and Management
CiteScore
2.20
自引率
0.00%
发文量
226
审稿时长
20 weeks
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