初级卫生保健人员与专科医务人员在提供整合服务中的协作模式及效果：概况性评价

doi:10.12114/j.issn.1007-9572.2023.0204

中国全科医学 ›› 2024, Vol. 27 ›› Issue (04): 400-407.DOI: 10.12114/j.issn.1007-9572.2023.0204

• 论著·中国全科医疗/社区卫生服务工作研究 • 上一篇下一篇

初级卫生保健人员与专科医务人员在提供整合服务中的协作模式及效果：概况性评价

张晓乙¹, 许智涵², 袁蓓蓓³^,^*(), 王胜¹, 刘晓⁴, 周慧兰⁵, 李战胜¹^,^*()

1．261061　山东省潍坊市卫生健康委员会
2．100191　北京市，北京大学医学人文学院
3．100191　北京市，北京大学中国卫生发展研究中心
4．261053　山东省潍坊市，潍坊医学院管理学院
5．100191　北京市，北京大学护理学院

收稿日期:2023-04-28 修回日期:2023-07-17 出版日期:2024-02-05 发布日期:2023-11-09
通讯作者: 袁蓓蓓, 李战胜
作者贡献：张晓乙、袁蓓蓓、李战胜确定文章立题，撰写论文，对文章负责；许智涵参与论文撰写；王胜、刘晓参与论文修订；周慧兰负责数据提取，参与论文修订。
基金资助:
山东省医药卫生科技发展计划项目(202115021133); 国家自然科学基金资助项目(72274006)

Patterns and Effects of Collaboration between Primary Care Providers and Medical Specialists in the Delivery of Integrated Health Care Services: a Scoping Review

ZHANG Xiaoyi¹, XU Zhihan², YUAN Beibei³^,^*(), WANG Sheng¹, LIU Xiao⁴, ZHOU Huilan⁵, LI Zhansheng¹^,^*()

1. Health Commission of Weifang, Weifang 261061, China
2. The School of Health Humanities, Peking University, Beijing 100191, China
3. PKU China Center for Health Development Studies, Peking University, Beijing 100191, China
4. School of Management, Weifang Medical University, Weifang 261053, China
5. The School of Nursing, Peking University, Beijing 100191, China

Received:2023-04-28 Revised:2023-07-17 Published:2024-02-05 Online:2023-11-09
Contact: YUAN Beibei, LI Zhansheng

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摘要/Abstract

摘要： 背景应对当前健康挑战需要为患者提供整合和连续性服务，初级卫生保健人员与全科医生外其他专科医务人员协作是最常见的实现途径，不同学科人员之间协作的模式及效果直接影响整合服务的提供质量，并对患者的健康结局改善至关重要。目的采用概况性评价的方法，对初级卫生保健人员与专科医务人员协作模式相关研究特征、协作模式内容、作者报告的协作模式效果进行系统梳理。方法于2022-09-03，系统检索PubMed、EmBase、Web of Science、中国知网、万方数据知识服务平台中与初级卫生保健人员和专科医务人员协作相关的文献，检索时限设定为建库至检索当日。提取纳入文献的基本特征、协作模式特征及效果。基于Mulave齿轮模型对团队协作模式进行元素分解，结合内容分析法对文献中的协作模式内容进行整合和展示。结果最终纳入与主题相关的文献420篇，其中214篇（51.0%）的研究目的为评价协作模式效果，但仅82篇（19.5%）能够提取出具体的协作方式内容。提取有限的协作模式细节信息发现，初级卫生保健人员和专科医务人员协作模式的突出特点是共同工作方式明确且正规、协作服务内容有循证指南/规范支持、在两类人员协作中有信息系统和专职协调人员的支持。82篇文献中，54篇（65.9%）文献报告了明确的效果指标，其中90.7%（49/54）的结论为协作对服务提供过程、服务利用和健康结果相关指标的改善有影响，但较高比例（90.7%，49/54）的研究报告正面效果不能排除发表偏倚的存在。结论整合型服务使用初级卫生保健人员和专科医务人员协作模式时，需要确保两类人员合作方式、工作内容的明确化，同时注重信息和协调人员的支持作用；卫生体系与政策相关干预研究应重视对干预设计细节和执行过程的描述，未来有必要对该主题研究开展方法学质量评价和Meta分析。

关键词: 初级卫生保健, 全科医生, 专科医生, 多学科团队, 协作模式, 整合医疗, 概况性评价

Abstract:

Background

Addressing current health challenges requires the integrated and continuous health care services. The collaboration between primary care providers (PCPs) and medical specialists other than general practice is the most common means of achieving this objective. The patterns and effect of collaborative working between different disciplines has a direct impact on the quality of integrated service delivery, which is critical to improving patient health outcomes.

Objective

To systematically review the characteristics of studies related to collaboration patterns between PCPs and medical specialists, contents of collaboration patterns and effects reported by the authors by using scoping review methods.

Methods

On September 3 in 2022, PubMed, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform were searched for literature related to collaboration between PCPs and medical specialists from inception to the date of search. The characteristics of literature, collaboration patterns and effects were extracted. The elemental decomposition of collaboration patterns was performed based on Mulave 'Gearing Up' model and the contents of collaboration patterns were integrated and demonstrated using content analysis method.

Results

A total of 420 relevant papers were included, of which 214 (51.0%) were committed to evaluating the effects of collaboration patterns, but specific contents of collaboration patterns could be extracted from 82 (19.5%) papers. The distinctive characteristics revealed by the extraction of limited information on the details of collaboration patterns included clear and formalized collaboration patterns, evidence-based guidelines/norms support for collaborative service contents, information systems and dedicated coordinators support for the collaboration between PCPs and specialists. Among the 82 papers, a total of 54 (65.9%) papers clearly reported indicators of effect, of which 90.7% (49/54) reported positive impact on service delivery and outcomes, ranging from service provision process, service utilization and health-related outcome indicators, however, higher proportion (90.7%, 49/54) of studies reporting positive effects could not exclude the presence of publication bias.

Conclusion

When collaboration patterns between PCPs and medical specialists other than general practice are implemented in integrated health services, it is necessary to ensure that approaches and contents of collaboration are specified, as well as the focus on the support of information systems and coordinators. Intervention studies related to health system and policy should emphasize describing the details of intervention design and implementation processes. Methodological quality assessment and meta-analysis are necessary to conduct in future studies on this topic.

Key words: Primary health care, General practitioners, Specialist, Multidisciplinary team, Collaborative mode, Intergratvie medicine, Scoping review

张晓乙,许智涵,袁蓓蓓,等. 初级卫生保健人员与专科医务人员在提供整合服务中的协作模式及效果：概况性评价[J]. 中国全科医学, 2024, 27(04): 400-407. DOI: 10.12114/j.issn.1007-9572.2023.0204.
ZHANG Xiaoyi,XU Zhihan,YUAN Beibei, et al. Patterns and Effects of Collaboration between Primary Care Providers and Medical Specialists in the Delivery of Integrated Health Care Services: a Scoping Review[J]. Chinese General Practice, 2024, 27(04): 400-407. DOI: 10.12114/j.issn.1007-9572.2023.0204.

图/表 6

表1 PubMed数据库检索策略

Table 1 Search strategy in PubMed

步骤	策略
#1	（（"multidisciplinary"[Title/Abstract]） OR（"interprofessional"[Title/Abstract]） OR（"interdisciplinary"[Title/Abstract]） OR（"multiple disciplines"[Title/Abstract]） OR（"specialist"[Title/Abstract]） OR（"general practitioner"[Title/Abstract]） OR（"general practice"[Title/Abstract]） OR（"family doctor"[Title/Abstract]））
#2	（（"collaboration"[Title/Abstract]） OR（"team"[Title/Abstract]） OR（"teamwork"[Title/Abstract]） OR（"cooperation"[Title/Abstract]））
#3	（（"patient-centered care"[MeSH Terms]） OR（"continuity of patient care"[MeSH Terms]） OR（"quality of health care"[MeSH Terms]） OR（"quality improvement"[MeSH Terms]））
#4	（（"primary health care"[MeSH Terms]） OR（"primary care"[Title/Abstract]） OR（"primary healthcare"[Title/Abstract]） OR（"community health care"[Title/Abstract]） OR（"community health service"[Title/Abstract]））
#5	#1 AND #2 AND #3 AND #4

图1 文献筛选流程及结果

Figure 1 Literature screening flow chart

图2 初级卫生保健人员-专科医务人员协作文献发文量的年度分布注：1977—1996年部分年份未检索到相应文献，故未在图中显示；2022年文献检索至2022-09-03。

Figure 2 Annual distribution of publications on PCP-specialist collaboration

图3 初级卫生保健人员-专科医务人员协作文献发文量的国家分布

Figure 3 Country distribution of publications on PCP-specialist collaboration

图4 初级卫生保健人员-专科医务人员协作模式覆盖疾病类型及数量

Figure 4 Categories and number of diseases covered by PCP-specialist collaboration

图5 初级卫生保健人员-专科医务人员协作模式涉及的专科医务人员种类及数量

Figure 5 Types and number of specialists involved in PCP-specialist collaboration

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初级卫生保健人员与专科医务人员在提供整合服务中的协作模式及效果：概况性评价

Patterns and Effects of Collaboration between Primary Care Providers and Medical Specialists in the Delivery of Integrated Health Care Services: a Scoping Review

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