Wensing Michel, van den Hombergh Pieter, Akkermans Reinier, van Doremalen Jan, Grol Richard
Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
Health Policy. 2006 Aug;77(3):260-7. doi: 10.1016/j.healthpol.2005.07.010. Epub 2005 Aug 29.
To determine the impact of practice size and scope of services on average physician workload in primary care practices in The Netherlands, and to examine the associations between average physician workload, average assistant volume and organisational practice characteristics.
This was a cross-sectional study in 1188 general practices in The Netherlands. Measures included physician workload per week per 1000 patients, assistant volume per 1000 patients, practice size defined by number of registered patients (10 classes), scope of disease management services (seven classes), and nine organisational characteristics of the practice.
Physician workload per 1000 patients differed across levels of practice size, but was not related with the range of disease management services provided. In the smallest practices physicians worked on average 26.2h per 1000 patients and in the largest practices 18.1h. A higher average assistant volume was overall not associated with a lower average physician workload. Large practices had lower assistant volume per 1000 patients, but provided a wider range of disease management services compared to small practices. Delegation of medical tasks was associated with reduced physician workload per 1000 patients, mainly in smaller practices, and with higher assistant volume per 1000 patients, particularly in larger practices.
In The Netherlands the optimum regarding average physician workload was found in the largest practices, while no obvious association with scope of disease management services appeared. It may be that in large practices medical tasks were delegated to practice assistants to provide a wider scope of disease management services and in small practice to reduce average physician workload.
确定荷兰初级医疗实践中诊所规模和服务范围对医生平均工作量的影响，并研究医生平均工作量、助理平均数量与诊所组织特征之间的关联。
这是一项对荷兰1188家普通诊所的横断面研究。测量指标包括每1000名患者每周的医生工作量、每1000名患者的助理数量、由注册患者数量定义的诊所规模（10个类别）、疾病管理服务范围（7个类别）以及诊所的9个组织特征。
每1000名患者的医生工作量在不同诊所规模水平上存在差异，但与所提供的疾病管理服务范围无关。在规模最小的诊所中，医生平均每1000名患者工作26.2小时，而在规模最大的诊所中为18.1小时。总体而言，较高的助理平均数量与较低的医生平均工作量无关。大型诊所每1000名患者的助理数量较少，但与小型诊所相比，提供的疾病管理服务范围更广。医疗任务的委托与每1000名患者的医生工作量减少相关，主要在较小的诊所中，并且与每1000名患者较高的助理数量相关，尤其是在较大的诊所中。
在荷兰，规模最大的诊所中医生平均工作量达到最佳状态，而与疾病管理服务范围未呈现明显关联。可能在大型诊所中，医疗任务被委托给诊所助理以提供更广泛的疾病管理服务，而在小型诊所中则是为了减少医生平均工作量。
