Sommers L S, Hacker T W, Schneider D M, Pugno P A, Garrett J B
Internal Medicine Residency Program, St Mary's Medical Center, San Francisco, CA 94117-1079, USA.
West J Med. 2001 Mar;174(3):175-9. doi: 10.1136/ewjm.174.3.175.
To explore the nature of managed-care hassles in primary care physicians' offices and to determine the feasibility of practice-based research methods to study the problem.
16 internists and 10 family physicians volunteered to collect data about managed-care hassles during or shortly after the office visit for 15 consecutive patients using preprinted data cards. Outcome measures Number of hassles, time required for hassles, and interference with quality of care and doctor-patient relationship.
Physicians adapted easily to using data cards. Before the pilot study, participants estimated a hassle rate of 10% and thought that interference with quality of care and the doctor-patient relationship was infrequent. Of 376 total visits for which the physicians completed data cards, 23% of visits generated 1 or more hassles. On average, a physician who saw 22 patients daily experienced 1 hassle lasting 10 minutes for every 4 to 5 patients. More than 40% of hassles were reported as interfering with quality of care, the doctor-patient relationship, or both.
The high hassle rate, in addition to the interference of hassles with quality of care and the doctor-patient relationship, suggests the need for further investigation into managed-care hassles using practice-based research methods.
探讨初级保健医生办公室中管理式医疗麻烦事的本质，并确定基于实践的研究方法来研究该问题的可行性。
16名内科医生和10名家庭医生自愿使用预先印制的数据卡，在连续15名患者的门诊期间或门诊后不久收集有关管理式医疗麻烦事的数据。结果测量指标包括麻烦事的数量、处理麻烦事所需的时间，以及对医疗质量和医患关系的干扰。
医生很容易适应使用数据卡。在试点研究之前，参与者估计麻烦事发生率为10%，并认为对医疗质量和医患关系的干扰很少见。在医生完成数据卡填写的376次就诊中，23%的就诊产生了1次或更多麻烦事。平均而言，一名每天看22名患者的医生每4至5名患者就会遇到一次持续10分钟的麻烦事。超过40%的麻烦事被报告为干扰了医疗质量、医患关系或两者。
高麻烦事发生率，以及麻烦事对医疗质量和医患关系的干扰，表明需要使用基于实践的研究方法对管理式医疗麻烦事进行进一步调查。
