O'Malley Ann S, Forrest Christopher B
Georgetown University Medical Center, Cancer Control Program, Lombardi Cancer Center, Washington, DC, USA.
J Gen Intern Med. 2002 Jan;17(1):66-74. doi: 10.1046/j.1525-1497.2002.10338.x.
To assess whether primary care performance of low-income women's primary care delivery sites is associated with the strength of their relationships with their physicians.
Random-digit-dial and targeted household telephone survey of a population-based sample.
Washington, D.C. census tracts with > or =30% of households below 200% of federal poverty threshold.
Women over age 40 (N=1,205), 82% of whom were African American.
The response rate was 85%. Primary care performance was assessed using women's ratings of their systems' accessibility (organizational, geographic, and financial), continuity, comprehensiveness, and coordination. Respondents' ratings of trust in their physicians, communication with their physicians, and compassion shown by their physicians were used to operationalize the patient-physician relationship. Controlling for population and insurance characteristics, 4 primary care features were positively associated with women's trust in and communication with their physicians: continuity with a single clinician, organizational accessibility of the practice, comprehensive care, and coordination of specialty care services. Better organizational access, but not geographic or financial access, was associated with greater levels of trust, compassion, and communication (odds ratios [ORs], 3.2, 7.4, and 6.9, respectively; P < or =.01). Women who rated highest their doctor's ability to take care of all of their health care needs (highest level of comprehensiveness) had 11 times the odds of trusting their physician (P < or =.01) and 6 times the odds of finding their physicians compassionate and communicative (P < or =.01), compared to those with the lowest level of comprehensiveness.
Primary care delivery sites organized to be more accessible, to link patients with the same clinician for their visits, to provide for all of a woman's health care needs, and to coordinate specialty care services are associated with stronger relationships between low-income women and their physicians. Primary care systems that fail to emphasize these features of primary care may jeopardize the clinician-patient relationship and indirectly the quality of care and health outcomes.
评估低收入女性初级保健服务机构的初级保健绩效是否与其与医生关系的紧密程度相关。
基于人群样本的随机数字拨号和定向家庭电话调查。
华盛顿特区人口普查区，其中30%或更多家庭收入低于联邦贫困线的200%。
40岁以上女性（N = 1205），其中82%为非裔美国人。
应答率为85%。初级保健绩效通过女性对其医疗系统的可及性（组织、地理和财务方面）、连续性、全面性和协调性的评分来评估。受访者对医生的信任度、与医生的沟通情况以及医生表现出的同情心用于衡量医患关系。在控制人口和保险特征后，4项初级保健特征与女性对医生的信任及沟通呈正相关：与单一临床医生的连续性、医疗机构的组织可及性、全面护理以及专科护理服务的协调性。更好的组织可及性，而非地理或财务可及性，与更高水平的信任、同情心和沟通相关（优势比[OR]分别为3.2、7.4和6.9；P≤0.01）。与全面性水平最低的女性相比，对医生满足其所有医疗保健需求能力评分最高（全面性水平最高）的女性信任医生的几率高出11倍（P≤0.01），认为医生富有同情心和善于沟通的几率高出6倍（P≤0.01）。
组织得更便于就诊、让患者就诊时由同一位临床医生负责、满足女性所有医疗保健需求并协调专科护理服务的初级保健服务机构，与低收入女性和她们的医生之间更强的关系相关。未能强调这些初级保健特征的初级保健系统可能会损害医患关系，进而间接影响医疗质量和健康结局。
