de Jong Judith D, Groenewegen Peter P, Westert Gert P
Nivel-Netherlands Institute of Health Services Research, PO Box 1568, 3500 BN, Utrecht, Netherlands.
Soc Sci Med. 2003 Oct;57(8):1515-24. doi: 10.1016/s0277-9536(02)00548-8.
The aim of this study was to find out whether or not general practitioners (GPs) within the same partnership show more similarities in attitudes and behaviour than GPs in different partnerships, and what the causes of these similarities might be. Knowledge of the causes of patterns of similarities within medical teams contributes to understanding medical practice variation, which is crucial in developing effective health care policies. Data were used from the Dutch National Survey of General Practice ('87/'88), consisting of a stratified sample of 161 Dutch GPs, who served 335,000 patients in total. To find out whether GPs in the same partnership are indeed more similar than GPs randomly chosen from different partnerships, we constructed two kinds of pairs: all possible pairs of GPs working in the same partnership (actual pairs), and randomly constructed pairs of GPs who are not working in the same partnership (random pairs). For each pair difference scores were computed for a variety of attitudes and behaviour. Difference scores for actual and random pairs were analysed using multi-level analysis. Most differences in attitudes and behaviour were smaller for actual pairs than for random pairs. Furthermore, in the majority of the cases differences were no longer statistically significant after explanatory variables indicating selection, gradual adaptation and rapid adaptation through shared circumstances were taken into account. It was found that Dutch GPs working in the same partnership showed more resemblance in attitudes and behaviour than GPs not working in the same partnership. Most indications point towards circumstances, and to a lesser extent towards adaptation, as an explanation of similarities within partnerships. The implication of this study is that medical practice variations are not merely individual differences in preferred practice style, but are patterned by social processes in partnerships and local circumstances.
本研究的目的是查明在同一合伙关系中的全科医生（GPs）在态度和行为上是否比不同合伙关系中的全科医生表现出更多的相似性，以及这些相似性的原因可能是什么。了解医疗团队中相似模式的原因有助于理解医疗实践差异，这对制定有效的医疗保健政策至关重要。数据来自荷兰全科医学国家调查（'87/'88），该调查由161名荷兰全科医生的分层样本组成，他们总共为335,000名患者提供服务。为了查明同一合伙关系中的全科医生是否确实比从不同合伙关系中随机挑选的全科医生更相似，我们构建了两种配对：在同一合伙关系中工作的全科医生的所有可能配对（实际配对），以及随机构建的不在同一合伙关系中工作的全科医生配对（随机配对）。对于每一对，计算了各种态度和行为的差异分数。使用多层次分析对实际配对和随机配对的差异分数进行了分析。实际配对的大多数态度和行为差异比随机配对的要小。此外，在大多数情况下，在考虑了表明通过共同环境进行选择、逐步适应和快速适应的解释变量后，差异不再具有统计学意义。研究发现，在同一合伙关系中工作的荷兰全科医生在态度和行为上比不在同一合伙关系中工作的全科医生表现出更多的相似性。大多数迹象表明，合伙关系中的相似性可以用环境来解释，在较小程度上也可以用适应来解释。这项研究的意义在于，医疗实践差异不仅仅是个人在偏好的实践风格上的差异，而是由合伙关系中的社会过程和当地环境所塑造的。
