Keenan J M, Boling P E, Schwartzberg J G, Olson L, Schneiderman M, McCaffrey D J, Ripsin C M
Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414.
Arch Intern Med. 1992 Oct;152(10):2025-32.
Over the past decade, while physician home visiting has continued to decline, the home care industry has been experiencing dramatic growth. In response, several major physician organizations have been encouraging increased physician education and involvement in home care and urging related health policy changes. This study provides the first in-depth, nationally representative descriptive data on the current home visiting practice and related attitudes of physicians.
Data were gathered through a structured 15-minute telephone survey, consisting of 141 items covering physician's general practice, personal home visiting practice, interaction with other home care providers, and attitudes regarding home care issues. Subjects were a nationally representative, randomly selected sample of 2200 family practice physicians (FPs) and internal medicine physicians (IMs) currently in active practice with at least 10 hours per week of professional time spent in ambulatory care.
Sixty-five percent of eligible participants completed the survey. Of all physicians surveyed, 65% of FPs and 44% of IMs reported that they may make house calls (P less than .001). Mean number of visits per year was 21.2 (median, 10) for FPs, and it was 15.7 (median, 6) for IMs. Physicians in rural practice were more likely to make home visits (P less than .001). Physician attitudes related to home care reflect a strong dissatisfaction with reimbursement, but positive opinions about the use of other home care professionals and the importance of home visits for selected patients. Logistic regression analysis comparing home-visiting physicians with non-visiting physicians allowed for prediction of the correct classification 73% of the time, and it revealed six variables that were significant predictors of home visiting. The strongest of these predictors were the physician's positive attitude regarding the importance of home visits for selected patients and his or her perception of having time available for home visits. Other significant variables predictive of home visiting were family practice specialty, rural location of practice, greater numbers of referrals to home care agencies, and, interestingly, dissatisfaction with reimbursement.
Although the great majority (over 75%) of FPs and IMs still regard the physician home visit as important for the care of selected patients, only about half report making one or more home visits within a 12-month period. Family physicians generally report a greater involvement in home care than do IMs. Physician reimbursement for home visits is perceived to be inadequate, and almost half (45%) indicate that they would do more home visits if reimbursement were increased. Most physicians (over 80%) have the opinion that home care agencies should be used more.
在过去十年中，虽然医生上门家访的情况持续减少，但家庭护理行业却在经历显著增长。对此，几个主要的医生组织一直在鼓励加强医生对家庭护理的教育和参与，并敦促相关卫生政策做出改变。本研究提供了关于当前上门家访实践以及医生相关态度的首份深入的、具有全国代表性的描述性数据。
通过一项15分钟的结构化电话调查收集数据，该调查包含141个项目，涵盖医生的一般执业情况、个人上门家访实践、与其他家庭护理提供者的互动以及对家庭护理问题的态度。研究对象是从全国范围内随机抽取的2200名家庭医生（FPs）和内科医生（IMs）的代表性样本，这些医生目前仍在积极执业，每周至少有10小时用于门诊护理。
65%的符合条件参与者完成了调查。在所有接受调查的医生中，65%的家庭医生和44%的内科医生报告称他们可能会进行上门家访（P小于0.001）。家庭医生每年的平均家访次数为21.2次（中位数为10次），内科医生为15.7次（中位数为6次）。在农村执业的医生更有可能进行上门家访（P小于0.001）。医生对家庭护理的态度反映出对报销的强烈不满，但对使用其他家庭护理专业人员以及对特定患者上门家访的重要性持积极看法。对上门家访医生和非上门家访医生进行逻辑回归分析，正确分类预测的准确率为73%，并揭示了六个是上门家访重要预测因素的变量。其中最强的预测因素是医生对特定患者上门家访重要性的积极态度以及他或她认为有时间进行上门家访的看法。其他预测上门家访的重要变量包括家庭医学专业、农村执业地点、更多转介至家庭护理机构，有趣的是，还有对报销的不满。
虽然绝大多数（超过75%）的家庭医生和内科医生仍然认为医生上门家访对特定患者的护理很重要，但只有约一半的医生报告在12个月内进行了一次或多次上门家访。家庭医生一般比内科医生报告更多地参与家庭护理。医生上门家访的报销被认为不足，近一半（45%）的医生表示如果报销增加，他们会进行更多的上门家访。大多数医生（超过80%）认为应该更多地使用家庭护理机构。
