Pearson Steven D, Kleinman Ken, Rusinak Donna, Levinson Wendy
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
Arch Intern Med. 2006 Mar 27;166(6):623-8. doi: 10.1001/archinte.166.6.623.
Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients. However, limited data on the outcomes of disclosure exist to guide policy.
This randomized trial was conducted among 8000 adult patients at 2 multispecialty group practices based in the Boston, Mass, and Los Angeles, Calif, areas. Intervention patients were mailed a compensation disclosure letter written by the chief medical officer of their physician group, and all patients were surveyed approximately 3 months later.
Disclosure patients were significantly more able to identify correctly the compensation model of their primary care physician, in Boston (adjusted odds ratio, 2.30; 95% confidence interval, 1.92-2.75) and in Los Angeles (adjusted odds ratio, 1.37; 95% confidence interval, 1.03-1.82). Disclosure patients also had more confidence in their ability to judge the possible influence of incentives on their health care: in Boston, 32.5% vs 17.8% (P<.001); and in Los Angeles, 31.8% vs 26.4% (P = .20). The disclosure intervention did not change trust in primary care physicians overall. However, of patients who remembered receiving the disclosure, 21.4% in Boston and 24.4% in Los Angeles responded that the disclosure had increased trust either greatly or somewhat, while in both cities less than 5% of patients responded that the information decreased trust. Patients' loyalty to their physician group was higher among disclosure patients in Boston (73.4% vs 70.2%; P = .03) and Los Angeles (74.1% vs 66.9%; P = .08).
Among diverse patient populations, a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians' compensation models. Patients' trust in their physicians was unharmed, and their loyalty to their physician group was strengthened. For physician groups with similar compensation programs, disclosure to patients should be considered an effective method to enhance the patient-physician relationship.
对医生经济利益冲突的担忧促使人们呼吁向患者披露经济激励措施。然而，关于披露结果的可用数据有限，难以指导政策制定。
这项随机试验在马萨诸塞州波士顿市和加利福尼亚州洛杉矶市的2家多专科医疗集团的8000名成年患者中进行。干预组患者收到了由其医生集团首席医疗官撰写的薪酬披露信，大约3个月后对所有患者进行了调查。
在波士顿，披露组患者更能正确识别其初级保健医生的薪酬模式（调整优势比为2.30；95%置信区间为1.92 - 2.75），在洛杉矶也是如此（调整优势比为1.37；95%置信区间为1.03 - 1.82）。披露组患者对自己判断激励措施对其医疗保健可能产生影响的能力也更有信心：在波士顿，分别为32.5%和17.8%（P <.001）；在洛杉矶，分别为31.8%和26.4%（P = 0.2）。披露干预总体上并未改变患者对初级保健医生的信任。然而，在记得收到披露信的患者中，波士顿有21.4%、洛杉矶有24.4%的患者表示披露极大或一定程度上增加了信任，而在两个城市中，不到5%的患者表示该信息降低了信任。在波士顿（73.4%对70.2%；P = 0.03）和洛杉矶（74.1%对66.9%；P = 0.08），披露组患者对其医生集团的忠诚度更高。
在不同患者群体中，医生集团邮寄的单一披露信与患者对医生薪酬模式了解的改善相关。患者对医生的信任未受损害，且他们对医生集团的忠诚度得到加强。对于具有类似薪酬方案的医生集团，向患者披露应被视为增强医患关系的有效方法。
