Dunt D, Elsworth G, Southern D, Harris C, Potiriadis M, Young D
Program Evaluation Unit, Department of Public Health, The University of Melbourne, Victoria, Australia.
Soc Sci Med. 2006 Aug;63(3):680-90. doi: 10.1016/j.socscimed.2006.01.014. Epub 2006 Mar 9.
The further integration of primary care within the wider health system is an imperative for reform in all countries. The aim of this paper is to determine the factors associated with general practitioner (GP) integration using the GP Integration Index which has been recently developed and is demonstrating good reliability. The analysis is based on a database derived from an Australia-wide mail questionnaire survey of 1874 GPs drawn from a 20% stratified random sample of 123 Divisions of General Practice (47.8% adjusted response rate). The GP Integration Index measures the level of GPs' integration with the health care system based upon a description of their own behaviour. It consists of nine GP integration factors, and their two associated higher-order factors-Primary Care Management (PCM) and Community Health Role (CHR)-as well as five GP integration enabling factors. A multivariate multilevel analysis was undertaken. An explanatory model for both PCM and CHR was tested based on the GP integration factors as well as general practice, GP and regional characteristics. CHR and PCM were most strongly associated with GP integration enabling factors (mainly at the individual-level) and, for CHR only, with urban-rural location (mainly at the area-level). The most important single explanatory variable for both PCM and CHR was the GP integration enabling factor, "Knowledge of local resources." The important explanatory variables were those reflecting the way GPs work, rather than their broad 'classification' within individual or GP-setting groupings. Based on these results, some revision to the proposed model was necessary. We conclude that processes of care factors (as compared to structure of care factors) are more important in relation to GP integration than previously recognised. Future policy initiatives to promote GP integration should focus on programs to improve GP's knowledge of local resources.
在所有国家，将初级保健进一步融入更广泛的卫生系统都是改革的当务之急。本文旨在使用最近开发且可靠性良好的全科医生（GP）整合指数来确定与GP整合相关的因素。该分析基于一个数据库，该数据库来自对澳大利亚123个全科医疗分区中20%分层随机抽取的1874名GP进行的全澳邮件问卷调查（调整后回复率为47.8%）。GP整合指数根据GP自身行为的描述来衡量其与医疗保健系统的整合水平。它由九个GP整合因素及其两个相关的高阶因素——初级保健管理（PCM）和社区卫生角色（CHR）——以及五个促进GP整合的因素组成。进行了多变量多层次分析。基于GP整合因素以及全科医疗、GP和区域特征，对PCM和CHR的解释模型进行了测试。CHR和PCM与促进GP整合的因素（主要在个体层面）关联最为紧密，仅对于CHR而言，还与城乡位置（主要在地区层面）有关。对于PCM和CHR而言，最重要的单一解释变量是促进GP整合的因素“对当地资源的了解”。重要的解释变量是那些反映GP工作方式的变量，而非他们在个体或GP设置分组中的宽泛“分类”。基于这些结果，有必要对提议的模型进行一些修订。我们得出结论，与之前认识到的相比，护理因素过程（与护理因素结构相比）在GP整合方面更为重要。未来促进GP整合的政策举措应侧重于提高GP对当地资源了解的项目。
