Kearley K E, Freeman G K, Heath A
Imperial College School of Medicine, London.
Br J Gen Pract. 2001 Sep;51(470):712-8.
Within the context of general practice, continuity of care creates an opportunity for a personal doctor-patient relationship to develop which has been associated with significant benefits for patients and general practitioners (GPs). Continuity of care is, however, threatened by trends in the organisational development of primary health care in the United Kingdom and its intrinsic role within general practice is currently the subject of debate.
To determine how many patients report having a personal doctor and when this is most valued, to compare the value of a personal doctor-patient relationship with that of convenience, and to relate these findings to a range of patient, GP, and practice variables.
Cross sectional postal questionnaire study.
Nine hundred and ninety-six randomly selected adult patients from a stratified random sample of 18 practices and 284 GP principals in Oxfordshire.
Qualitative interviews with patients and GPs were conducted and used to derive a parallel patient and GP questionnaire. Each patient (100 from each practice) was invited to complete a questionnaire to evaluate their experience and views concerning personal care. All GP principals currently practising in Oxfordshire were sent a similar questionnaire, which also included demographic variables.
Overall, 75% of patients reported having at least one personal GP. The number of patients reporting a personal GP in each practice varied from 53% to 92%. Having a personal doctor-patient relationship was highly valued by patients and GPs, in particular for more serious, psychological and family issues when 77-88% of patients and 80-98% of GPs valued a personal relationship more than a convenient appointment. For minor illness it had much less value.
Patients and GPs particularly value a personal doctor-patient relationship for more serious or for psychological problems. Whether a patient has a personal GP is associated with their perception of its importance and with factors which create an opportunity for a relationship to evolve.
在全科医疗的背景下,连续性医疗为建立个人化的医患关系创造了机会,这种关系已被证明对患者和全科医生都有显著益处。然而,英国初级医疗保健组织发展的趋势对连续性医疗构成了威胁,其在全科医疗中的内在作用目前仍是一个有争议的话题。
确定有多少患者报告有个人医生以及何时最重视个人医生,比较个人化医患关系与便利性的价值,并将这些发现与一系列患者、全科医生和医疗机构变量相关联。
横断面邮寄问卷调查研究。
从牛津郡18家医疗机构和284名全科医生的分层随机样本中随机选取996名成年患者。
对患者和全科医生进行定性访谈,并据此编制了一份平行的患者问卷和全科医生问卷。邀请每位患者(每家医疗机构100名)填写问卷,以评估他们对个人化医疗的体验和看法。向目前在牛津郡执业的所有全科医生发放了一份类似的问卷,其中还包括人口统计学变量。
总体而言,75%的患者报告至少有一位个人全科医生。每家医疗机构中报告有个人全科医生的患者比例从53%到92%不等。患者和全科医生都非常重视个人化的医患关系,特别是在处理更严重、心理和家庭问题时,77% - 88%的患者和80% - 98%的全科医生认为个人关系比便捷预约更重要。对于小病,其价值则要小得多。
患者和全科医生尤其重视在处理更严重或心理问题时的个人化医患关系。患者是否有个人全科医生与其对这种关系重要性的认知以及与促使关系发展的因素有关。