Parkerton Patricia H, Wagner Edward H, Smith Dean G, Straley Hugh L
Department of Health Services, UCLA School of Public Health, University of California at Los Angeles, Box 91772, Los Angeles, CA 90095-1772, USA.
J Gen Intern Med. 2003 Sep;18(9):717-24. doi: 10.1046/j.1525-1497.2003.20401.x.
Primary care physicians are spending fewer hours in direct patient care, yet it is not known whether reduced hours are associated with differences in patient outcomes.
To determine whether patient outcomes vary with physicians' clinic hours.
Cross-sectional retrospective design assessing primary care practices in 1998.
All 25 outpatient-clinics of a single medical group in western Washington.
One hundred ninety-four family practitioners and general internists, 80% of whom were part-time, who provided ambulatory primary care services to specified HMO patient panels. Physician appointment hours ranged from 10 to 35 per week (30% to 100% of full time).
Twenty-three measures of individual primary care physician performance collected in an administrative database were aggregated into 4 outcome measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. Multivariate regression on each of the 4 outcomes controlled for characteristics of physicians (administrative role, gender, seniority) and patient panels (size, case mix, age, gender).
While the effects were small, part-time physicians had significantly higher rates for cancer screening (4% higher, P =.001), diabetic management (3% higher, P =.033), and for patient satisfaction (3% higher, P =.035). After controlling for potential confounders, there was no significant association with patient satisfaction (P =.212) or ambulatory costs (P =.323).
Primary care physicians working fewer clinical hours were associated with higher quality performance than were physicians working longer hours, but with patient satisfaction and ambulatory costs similar to those of physicians working longer hours. The trend toward part-time clinical practice by primary care physicians may occur without harm to patient outcomes.
基层医疗医生直接为患者提供诊疗服务的时间越来越少，但尚不清楚工作时间减少是否与患者治疗结果的差异有关。
确定患者治疗结果是否因医生门诊时间而异。
1998年评估基层医疗实践的横断面回顾性设计。
华盛顿州西部一个医疗集团的所有25家门诊诊所。
194名家庭医生和普通内科医生，其中80%为兼职，他们为特定的健康维护组织（HMO）患者群体提供门诊基层医疗服务。医生的预约时间为每周10至35小时（全职的30%至100%）。
在一个行政数据库中收集的23项个体基层医疗医生绩效指标被汇总为4项结果指标：癌症筛查、糖尿病管理、患者满意度和门诊费用。对这4项结果指标分别进行多变量回归分析，控制医生特征（行政角色、性别、资历）和患者群体特征（规模、病例组合、年龄、性别）。
虽然影响较小，但兼职医生的癌症筛查率（高4%，P = 0.001）、糖尿病管理率（高3%，P = 0.033）和患者满意度（高3%，P = 0.035）显著更高。在控制潜在混杂因素后，与患者满意度（P = 0.212）或门诊费用（P = 0.323）无显著关联。
与工作时间较长的医生相比，临床工作时间较少的基层医疗医生的工作表现质量更高，但患者满意度和门诊费用与工作时间较长的医生相似。基层医疗医生兼职临床实践的趋势可能不会对患者治疗结果造成损害。
