Parchman Michael L, Burge Sandra K
Department of Family and Community Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX 78229-3900, USA.
Fam Med. 2004 Jan;36(1):22-7.
The importance of a sustained relationship between patients and physicians is a defining characteristic of family medicine. This study examined whether there is an association among the length of the patient-physician relationship, various attributes of primary care, and the delivery of clinical preventive services to Medicare beneficiaries.
The data source for this study was the 1993 Medicare Current Beneficiary Survey. Primary care attribute scales were developed by conducting a factor analysis of 17 survey questions. Three clinical preventive services were measured as outcomes: influenza vaccination, mammography, and an eye examination for diabetics. Path analyses were used to test the relationships between length of relationship, primary care attributes, and delivery of clinical preventive services.
As the length of the relationship increased, scores on communication, accumulated knowledge of the patient by the physician, and trust all improved. Length of relationship and communication predicted accumulated knowledge of the patient by the physician, accumulated knowledge predicted trust, and trust predicted delivery of preventive services.
Among elderly Medicare beneficiaries, the ability to develop a sustained relationship with a provider is related to the realization of other important attributes of primary care. Trust was associated with delivery of important clinical preventive services. Efforts should be made to protect the ability of patients and physicians to sustain a relationship over time.
患者与医生之间持续关系的重要性是家庭医学的一个决定性特征。本研究调查了患者与医生关系的时长、初级保健的各种属性以及向医疗保险受益人提供临床预防服务之间是否存在关联。
本研究的数据来源是1993年医疗保险当前受益人调查。通过对17个调查问题进行因子分析，制定了初级保健属性量表。将三项临床预防服务作为结果进行衡量：流感疫苗接种、乳房X线摄影以及糖尿病患者的眼部检查。采用路径分析来检验关系时长、初级保健属性与临床预防服务提供之间的关系。
随着关系时长的增加，沟通得分、医生对患者的累积了解以及信任度均有所提高。关系时长和沟通可预测医生对患者的累积了解，累积了解可预测信任度，而信任度可预测预防服务的提供。
在老年医疗保险受益人中，与医疗服务提供者建立持续关系的能力与实现初级保健的其他重要属性相关。信任与重要临床预防服务的提供有关。应努力保护患者和医生长期维持关系的能力。
