Fernandez A, Grumbach K, Goitein L, Vranizan K, Osmond D H, Bindman A B
Primary Care Research Center, San Francisco General Hospital, San Francisco, CA 94110, USA.
Arch Intern Med. 2000 Oct 23;160(19):2902-8. doi: 10.1001/archinte.160.19.2902.
Increased use of hospitalists is redefining the role of primary care physicians. Whether primary care physicians welcome this transition is unknown. We examined primary care physicians' perceptions of how hospitalists affect their practices, their patient relationships, and overall patient care.
A mailed survey of randomly selected general internists, general pediatricians, and family practitioners with experience with hospitalists practicing in California.
Physicians' self-reports of hospitalists' effects on quality of patient care and on their own practices.
Seven hundred eight physicians were eligible for this study, and there was a 74% response rate. Of the 524 physicians who responded, 34% were internists, 38% were family practitioners, and 29% were pediatricians. Of the 524 respondents, 335 (64%) had hospitalists available to them and 120 (23%) were required to use hospitalists for all admissions. Physicians perceived hospitalists as increasing (41%) or not changing (44%) the overall quality of care and perceived their practice style differences as neutral or beneficial. Twenty-eight percent of primary care physicians believed that the quality of the physician-patient relationship decreased; 69% reported that hospitalists did not affect their income; 53% believed that hospitalists decreased their workload; and 50% believed that hospitalists increased practice satisfaction. In a multivariate model predicting physician perceptions, internists, physicians who attributed loss of income to hospitalists, and physicians in mandatory hospitalist systems viewed hospitalists less favorably.
Practicing primary care physicians have generally favorable perceptions of hospitalists' effect on patients and on their own practice satisfaction, especially in voluntary hospitalist systems that decrease the workload of primary care physicians and do not threaten their income. Primary care physicians, particularly internists, are less accepting of mandatory hospitalist systems. Arch Intern Med. 2000;160:2902-2908
医院医生使用的增加正在重新定义初级保健医生的角色。初级保健医生是否欢迎这一转变尚不清楚。我们研究了初级保健医生对医院医生如何影响他们的业务、他们与患者的关系以及整体患者护理的看法。
对在加利福尼亚州有医院医生从业经验的随机选择的普通内科医生、普通儿科医生和家庭医生进行邮寄调查。
医生关于医院医生对患者护理质量和他们自己业务影响的自我报告。
708名医生符合本研究条件，回复率为74%。在524名回复的医生中，34%是内科医生，38%是家庭医生，29%是儿科医生。在524名受访者中，335名（64%）可以获得医院医生的服务，120名（23%）被要求在所有住院治疗中使用医院医生。医生认为医院医生提高了（41%）或未改变（44%）整体护理质量，并认为他们的业务风格差异是中性的或有益的。28%的初级保健医生认为医患关系质量下降；69%报告医院医生没有影响他们的收入；53%认为医院医生减轻了他们的工作量；50%认为医院医生提高了业务满意度。在预测医生看法的多变量模型中，内科医生、将收入损失归因于医院医生的医生以及在强制性医院医生系统中的医生对医院医生的看法较差。
执业初级保健医生对医院医生对患者及其自身业务满意度的影响总体上看法良好，尤其是在减少初级保健医生工作量且不威胁其收入的自愿性医院医生系统中。初级保健医生，尤其是内科医生，对强制性医院医生系统的接受度较低。《内科学文献》。2000年；160:2902 - 2908
