Ehman Melissa G, Haas Jennifer S
Department of Medicine, San Francisco General Hospital, University of California, San Francisco CA, USA.
J Fam Pract. 2003 Nov;52(11):876-82.
Primary care physicians function as "gatekeepers" in many managed care systems. With the rapid growth of managed care enrollment, it is crucial that patients have adequate access to primary care physicians. We investigated factors associated with new-patient appointment availability of primary care physicians in the San Francisco Bay Area.
Observational cohort.
Cross-sectional survey of primary care physician offices in 2 San Francisco Bay Area counties (n=438).
New-patient appointment availability.
Seventy-five percent of primary care physicians participating in managed care had an appointment available for a new patient. Appointments were more likely to be available with primary care physicians who had been in practice for 10 years or less (odds ratio [OR]=4.2; 95% confidence interval [CI], 1.7-10.3), compared with more established physicians; and with primary care physicians who had graduated from a medical school outside of the United States (OR=3.5; 95% CI, 1.7-7.3), compared with US graduates. Appointments within 30 days were less available with female primary care physicians (OR=0.4; 95% CI, 0.2-0.7) than for male primary care physicians.
The limited availability of appointments for new patients may create barriers to primary care in the San Francisco Bay Area, a region with high managed-care penetration.
在许多管理式医疗系统中，初级保健医生充当“看门人”的角色。随着管理式医疗参保人数的迅速增长，患者能够充分接触到初级保健医生至关重要。我们调查了旧金山湾区初级保健医生新患者预约可及性的相关因素。
观察性队列研究。
对旧金山湾区两个县的初级保健医生办公室进行横断面调查（n = 438）。
新患者预约可及性。
参与管理式医疗的初级保健医生中，75%有新患者预约名额。与从业时间更长的医生相比，从业10年及以下的初级保健医生更有可能有预约名额（优势比[OR]=4.2；95%置信区间[CI]，1.7 - 10.3）；与美国医学院毕业生相比，毕业于美国以外医学院的初级保健医生更有可能有预约名额（OR = 3.5；95% CI，1.7 - 7.3）。与男性初级保健医生相比，女性初级保健医生在30天内的预约名额更少（OR = 0.4；95% CI，0.2 - 0.7）。
新患者预约名额有限可能会给旧金山湾区这个管理式医疗渗透率高的地区的初级保健造成障碍。
