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目的系统评价我国高血压患者在实施双向转诊干预之后的临床结局,为高血压患者双向转诊的推广提供依据。方法计算机检索Pub Med、Embase、Cochrane library、CNKI、VIP、CBM和Wan-fang data等数据库,检索时限均为建库至2016年9月,收集所有实施双向转诊干预措施与常规入院的高血压病例对照研究,按照JBI质量评价标准纳入病例对照研究,提取有效数据并采用Rev Man 5.3软件进行Meta分析。结果最终纳入7篇病例对照研究,共计1 639人,实施双向转诊途径838人,未实施双向转诊801人。与未实施双向转诊的高血压患者比较,实施双向转诊的高血压患者就诊时间[MD=-0.89,95%CI(-0.90,-0.88)]和平均住院日[MD=-2.04,95%CI(-2.18,-1.90)]明显缩短,再就诊率[OR=0.16,95%CI(0.11,0.23)]和医疗费用[MD=-302.52,95%CI(-309.06,295.97)]明显降低,差异有统计学意义(P<0.01);虽然治疗有效率较高[OR=2.29,95%CI(0.78,6.74)],但差异无统计学意义(P>0.05)。结论高血压患者通过双向转诊干预能有效节约就诊时间、缩短平均住院日、减少再就诊率和降低医疗费用,但对治疗效果无影响。
Objective To evaluate the clinical outcome of patients with hypertension in China after the two-way referral intervention, and provide the basis for the promotion of two-way referral in hypertensive patients. Methods The databases of PubMed, Embase, Cochrane Library, CNKI, VIP, CBM and Wan-fang data were searched by computer. The retrieval time was all from the establishment of the database to September 2016. All the patients who received bidirectional referral intervention and routine admission were included Case-control studies were included in the case-control study according to the JBI quality assessment criteria, valid data were extracted and Meta-analysis was performed using Rev Man 5.3 software. Results A total of 6 case-control studies were included in the study. A total of 1 639 people were enrolled in this study. 838 people were bidirectional referrals and 801 were not bidirectionally referred. Compared with hypertensive patients without bi-directional referral, the two-way referral hypertensive patients with treatment time [MD = -0.89,95% CI (-0.90, -0.88)] and average length of stay [MD = -2.04,95 % CI (-2.18, -1.90)] was significantly shortened. The rate of re-visit [OR = 0.16,95% CI (0.11,0.23)] and medical expenses [MD = -302.52,95% CI (-309.06,295.97)] was significantly lower (P <0.01). Although the treatment efficiency was higher (OR = 2.29, 95% CI 0.78, 6.74), the difference was not statistically significant (P> 0.05). Conclusions Hypertensive patients can save time on treatment, shorten the average length of stay, reduce the rate of re-visit and reduce medical costs through bidirectional referral intervention, but have no effect on the treatment effect.