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国外基层医疗中失智症整合照护模式范围综述

Primary care-based integrated dementia care models abroad: a scoping review

  • 摘要:
    目的 系统检索国外基层医疗中的失智症整合照护模式研究,总结其主要内容及关键要素,为构建本土化失智症社区整合照护模式提供参考。
    方法 根据范围综述的研究方法,检索Medline、Embase和Web of Science数据库中自建库至2023年7月1日有关基层医疗中失智症整合照护模式的文献,并进行筛选、特征提取及整合。
    结果 共检索文献3 357篇,最终纳入25篇,失智症整合照护模式分为协作照护计划、记忆诊所和照护网络;整合维度以服务、专业层面为主,系统、功能和规范层面最少;有效性主要体现为患者的健康结局、照护者的照护负担及服务可及性的改善,但与实施形式有关;资金缺乏、支付方式不统一、缺少共享信息技术平台、人才建设匮乏和全科医生能力不足是整合照护模式实施的主要阻碍因素;模式与当地基层医疗系统的关系主要是嵌入关系。
    结论 国外基层医疗中的失智症整合照护模式类型多样、效果各异,为构建我国失智老人社区整合照护模式提供了参考。应进一步争取政策支持,构建跨机构协作机制、建设基层多学科团队,加强社区卫生服务机构的信息化建设以及共同照护愿景,在临床层面实现真正的“以人为中心”的照护。

     

    Abstract:
    Objective To systematically review research of integrated dementia care models in primary care abroad, summarize the main dimensions and key elements of the models, and provide a reference for the construction of community-based integrated dementia care models in China.
    Methods Following the scoping review methodology, literature on integrated dementia care models in primary care published from database inception through July 1, 2023, was searched in Medline, Embase, and Web of Science databases. The literature was screened and characteristics extracted and synthesized.
    Results A total of 3 357 articles were retrieved and 25 were finally included. The integrated dementia care models were categorized into collaborative care plans, memory clinics and care networks. The dimensions of integration focused mainly on the service and professional levels, with the least emphasis on the system, functional and normative levels. Effectiveness was mainly reflected in improved health outcomes for patients, caregiver burden, and accessibility of services, but was related to the form of implementation. The main barriers to the implementation of integrated care models included lack of funding, inconsistent payment methods, short of common information technology platforms, insufficient human resource development, and inadequate skills among general practitioners. The relationship between the models and the local primary care system was mainly embedded.
    Conclusion The types of integrated dementia care models in primary care abroad are diverse and their effects vary. They provide a reference for building community-based integrated care models for older adults with dementia in China.

     

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