Kvamme O J, Sandvik L, Hjortdahl P
Stiftelse for helsetjenesteforskning, Sentralsykehuset i Akershus, Nordbyhagen, Oslo.
Tidsskr Nor Laegeforen. 2000 Sep 10;120(21):2499-502.
Norwegian general practice is a conglomerate of organisational forms. Studies of quality differences between types of practice have not been published. There is scant knowledge of how physician characteristics may influence patients' experience of the quality of care.
In this study of patient experiences with quality in primary care, we received answers to a questionnaire from more than 1,600 patients who had made office visits to 61 GPs working in 44 different practices. The patients expressed their opinion of the quality of medical-technical performance, doctor-patient relationship, information and support, accessibility and the organisation of general practice. Using multilevel analysis we compared solo-practices with group practices, and conventional types of practices with list-patient practices.
No significant differences in patient experienced quality were found for different practices with traditional organisation. List-patient practices scored lower on quality than conventional practices, especially on accessibility and organisation. There were no significant differences in patient evaluation related to the doctor's gender. GPs with more than ten years in a practice were rated lower on quality than GPs with ten or fewer years of experience.
The way general practice is organised and the number of years the GP has worked in the same practice appear to influence how patients experience the quality of primary health care.
挪威的全科医疗是多种组织形式的集合。关于不同类型医疗实践质量差异的研究尚未发表。对于医生特征如何影响患者对医疗质量的体验,人们知之甚少。
在这项关于患者对初级医疗质量体验的研究中,我们收到了1600多名患者对问卷的回答,这些患者曾拜访过在44种不同医疗实践中工作的61名全科医生。患者表达了他们对医疗技术表现、医患关系、信息与支持、可及性以及全科医疗组织的质量看法。我们使用多水平分析比较了个体医疗实践与团队医疗实践,以及传统类型医疗实践与按名单分配患者的医疗实践。
对于传统组织形式的不同医疗实践,患者体验到的质量没有显著差异。按名单分配患者的医疗实践在质量方面得分低于传统医疗实践,尤其是在可及性和组织方面。与医生性别相关的患者评价没有显著差异。在同一医疗实践中工作超过十年的全科医生在质量方面的评分低于工作十年及以下的全科医生。
全科医疗的组织方式以及全科医生在同一医疗实践中工作的年限似乎会影响患者对初级卫生保健质量的体验。