照護連續性之文獻回顧

A Literature Review of Continuity of Care

陳啟禎(Chi-Chen Chen) ； 鄭守夏(Shou-Hsia Cheng)

《台灣公共衛生雜誌》 32卷2期 (2013/04) Pp. 116-128

https://doi.org/10.6288/TJPH2013-32-02-03

摘要

照護連續性為初級照護的重要基礎。台灣全民健保實施後，高度就醫可近性和缺乏轉診機制，可能不利於照護連續性的提升。本文回顧照護連續性的概念、測量指標的演進和照護連續性與照護結果實證研究議題。我們搜尋MEDLINE及CEPS中文電子期刊服務之資料庫於1950年至2012年之研究，同時採用逐篇審視被引用文獻的方式定義出照護連續性相關的文獻，共計納入61篇文章。整體而言，照護連續性概念的定義已漸趨一致，人際面和資訊面為照護連續性兩個核心面向；由於行政資料庫的發展，照護連續性測量多以標準量化的指標為主。相較於早期的實證研究無一致性的結論，近期多數研究支持照護連續性可帶來較佳的照護結果和較低的醫療費用。本文建議未來的相關研究在方法學上，對於研究設計與處理時序性的議題、照護連續性測量指標的選擇等，應依研究目的考量其適用性。其次，有關照護連續性對照護結果的作用機轉，以及照護連續性各面向對於照護結果的相對影響力等議題，皆值得後續研究。

關鍵字

照護連續性 ； 照護結果 ； 回顧

並列摘要

Continuity of care (COC) is an essential issue in primary healthcare. Under the national health insurance (NHI) program in Taiwan, easy access to care and lack of referral may hamper the improvement of COC. This study reviews the evolution of the concept and measurement of COC, empirical studies concerning the relationship between COC and healthcare outcomes, and methodological issues. We retrieved studies from MEDLINE and Chinese Electronic Periodical Services databases from 1950 to 2012 and completed a manual review of cited articles to identify studies related to COC. A total of 61 studies were included in this review. In summary, there is emerging consensus on the concept of COC. ”Interpersonal” and ”information” are two essential dimensions of the concept of COC. Due to the increasing availability of administrative data, quantitative measures of COC have been commonly employed in recent studies. Compared to earlier studies with no consistent findings, the majority of recent studies have reported that better COC was associated with favorable healthcare outcomes and reduced healthcare expenses. We suggest that researchers consider the study design, handle temporal relationships between COC and healthcare outcome, and choose appropriate measures for determining COC according to their research objectives. In addition, future studies might focus on the mechanism between COC and healthcare outcomes, and the relative importance of various COC dimensions on healthcare outcomes. This review may be of interest to researchers in Taiwan.

並列關鍵字

continuity of care ； healthcare outcome ； review

參考文獻

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