Scott Anthony, Coote William
Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC, Australia.
Med J Aust. 2007 Jul 16;187(2):95-9. doi: 10.5694/j.1326-5377.2007.tb01149.x.
To examine the effect of Divisions of General Practice on various measures of primary care performance.
Regression analysis using longitudinal data across Australia.
All Divisions of General Practice between 2002 and 2004.
Fourteen indicators of primary care performance in the areas of general practice infrastructure, access, multidisciplinary working, chronic disease, and measurable aspects of quality of care.
Between 2002 and 2004, Divisions and the activities they performed were associated with a number of measures of primary care performance, particularly measures of general practice infrastructure. Of the total variation in each performance indicator, between 19% and 64% can be attributed to the influence of Divisions while controlling for remoteness, health needs, and general practitioner characteristics. In all regression models, these effects were significant (P < 0.05). Divisions that provided support in electronic communication and electronic transfer of data were associated with: a 0.56 (95% CI, 2 0.04 to 1.2; P = 0.07) percentage point increase in the proportion of Practice Incentives Program (PIP) practices; a 0.73 (95% CI, 2 0.09 to 1.5; P = 0.08) percentage point increase in the proportion of PIP practices with electronic prescribing software; and a 0.66 (95% CI, 0.05 to 1.3; P = 0.03) percentage point increase in the proportion of PIP practices with a modem. Divisions providing activities with an asthma focus were associated with a 0.84 (95% CI, 0.02 to 1.5; P = 0.01) percentage point increase in the proportion of PIP practices receiving the asthma sign-on payment. There were no significant effects of Division activities on clinical aspects of care, such as GP claims for Service Incentive Payments for asthma, diabetes or cervical screening.
Divisions of General Practice had an effect on primary care performance in a difficult health system context.
研究全科医学部门对初级保健绩效各项指标的影响。
使用澳大利亚纵向数据进行回归分析。
2002年至2004年间所有的全科医学部门。
初级保健绩效的14项指标，涉及全科医学基础设施、可及性、多学科协作、慢性病以及可衡量的医疗质量方面。
2002年至2004年间，全科医学部门及其开展的活动与多项初级保健绩效指标相关，尤其是全科医学基础设施指标。在控制偏远程度、健康需求和全科医生特征的情况下，每个绩效指标总变异的19%至64%可归因于全科医学部门的影响。在所有回归模型中，这些影响均具有统计学意义（P < 0.05）。提供电子通信和数据电子传输支持的部门与以下方面相关：参与实践激励计划（PIP）的诊所比例增加0.56个百分点（95%可信区间，2 0.04至1.2；P = 0.07）；配备电子处方软件的PIP诊所比例增加0.73个百分点（95%可信区间，2 0.09至1.5；P = 0.08）；配备调制解调器的PIP诊所比例增加0.66个百分点（95%可信区间，0.05至1.3；P = 0.03）。开展以哮喘为重点活动的部门与获得哮喘签约支付的PIP诊所比例增加0.84个百分点（95%可信区间，0.02至1.5；P = 0.01）相关。全科医学部门的活动对护理的临床方面没有显著影响，如全科医生申请哮喘、糖尿病或宫颈筛查的服务激励支付。
在艰难的卫生系统环境中，全科医学部门对初级保健绩效产生了影响。
