Carpiano Richard M, Flocke Susan A, Frank Scott H, Stange Kurt C
Department of Sociomedical Sciences, Joseph L. Mailman School of Public Health, Columbia University, 722 West 168th Street, 9th Floor, New York, NY 10032, USA.
Prev Med. 2003 Feb;36(2):131-40. doi: 10.1016/s0091-7435(02)00024-5.
Most research examining primary care office characteristics and preventive service delivery (PSD) has evaluated preventive service aids and equipment, while generally overlooking the complex interactions among multiple office systems where multiple factors influence the overall practice. We test a theoretical model of practice influences on PSD that accounts for Tools (preventive service aids/equipment), Teamwork (office organization), and Tenacity (prevention delivery attitudes).
Office characteristics and 4454 patient visits were observed for 138 family physicians in northeast Ohio. Utilizing U.S. Preventive Services Task Force recommendations, age- and gender-specific PSD summary scores were computed for each patient and then averaged per physician. Multivariate analysis of variance tested office characteristic associations with PSD scores.
Tools were common, but most were not significantly associated with PSD scores. The Teamwork indicators of clear staff role expectations and shared vision among physician and staff existed, respectively, for 80 and 73% of physicians. A high average reported practice focus on prevention existed, despite low staff involvement in PSD (22.2%). Compared with Tools, more Teamwork and Tenacity characteristics were associated with the PSD scores.
Teamwork and Tenacity appear to be more important than Tools in delivering preventive services in primary care practices.
大多数研究初级保健办公室特征和预防服务提供（PSD）的研究都评估了预防服务辅助工具和设备，而通常忽略了多个办公室系统之间复杂的相互作用，在这些系统中，多种因素影响着整体实践。我们测试了一个关于实践对PSD影响的理论模型，该模型考虑了工具（预防服务辅助工具/设备）、团队合作（办公室组织）和坚韧（预防服务提供态度）。
对俄亥俄州东北部的138名家庭医生的办公室特征和4454次患者就诊进行了观察。利用美国预防服务工作组的建议，计算每个患者的年龄和性别特异性PSD汇总分数，然后计算每位医生的平均分。多变量方差分析测试了办公室特征与PSD分数之间的关联。
工具很常见，但大多数与PSD分数没有显著关联。分别有80%和73%的医生存在明确的员工角色期望和医生与员工之间的共同愿景等团队合作指标。尽管员工参与PSD的比例较低（22.2%），但报告的实践对预防的关注平均水平较高。与工具相比，更多的团队合作和坚韧特征与PSD分数相关。
在初级保健实践中提供预防服务时，团队合作和坚韧似乎比工具更重要。
