Ginsburg M E, Kravitz R L, Sandberg W A
Sacramento Healthcare Decisions, 4747 Engle Rd Carmichael, CA 95608, USA.
West J Med. 2000 Dec;173(6):390-4. doi: 10.1136/ewjm.173.6.390.
To identify physicians' views regarding cost-containment and cost-effectiveness and their attitudes and experience using cost-effectiveness in clinical decision making.
A close-ended 30-item written survey.
1,000 randomly selected physicians whose practices currently encompass direct patient care and who work in the California counties of Sacramento, Yolo, Placer, Nevada, and El Dorado.
Physician attitudes about the role of cost and cost-effectiveness in treatment decisions, perceived barriers to cost-effective medical practice, and response of physicians and patients if there are conflicts about treatment that physicians consider either not indicated or not cost-effective.
Most physicians regard cost-effectiveness as an appropriate component of clinical decisions and think that only the treating physician and patient should decide what is cost-worthy. However, physicians are divided on whether they have a duty to offer medical interventions with remote chances of benefit regardless of cost, and they vary considerably in their interactions with patients when cost-effectiveness is an issue.
Although physicians in the Sacramento region accept cost-effectiveness as important and appropriate in clinical practice, there is little uniformity in how cost-effectiveness decisions are implemented.
确定医生对于成本控制和成本效益的看法，以及他们在临床决策中使用成本效益的态度和经验。
一份包含30个条目的封闭式书面调查问卷。
1000名随机挑选的医生，他们目前从事直接的患者护理工作，且工作地点在加利福尼亚州的萨克拉门托、约洛、普拉瑟、内华达和埃尔多拉多县。
医生对成本和成本效益在治疗决策中的作用的态度、成本效益医疗实践中感知到的障碍，以及如果在治疗方面存在冲突（医生认为该治疗不必要或不具有成本效益）时医生和患者的反应。
大多数医生认为成本效益是临床决策的一个适当组成部分，并认为只有治疗医生和患者应该决定什么是值得花费成本的。然而，医生们在是否有责任提供无论成本如何但获益机会渺茫的医疗干预措施上存在分歧，并且在成本效益成为问题时，他们与患者的互动方式也有很大差异。
尽管萨克拉门托地区的医生认为成本效益在临床实践中很重要且合适，但在如何实施成本效益决策方面几乎没有一致性。
