Farber Neil J, Jordan Michelle E, Silverstein Julie, Collier Virginia U, Weiner Joan, Boyer E Gil
University of California San Diego, La Jolla, CA 92037, USA.
J Gen Intern Med. 2008 Mar;23(3):283-7. doi: 10.1007/s11606-007-0495-7. Epub 2008 Jan 3.
There are few data available about factors which influence physicians' decisions to discharge patients from their practices. To study general internists' and family medicine physicians' attitudes and experiences in discharging patients from their practices.
A cross-sectional mailed survey was used.
One thousand general internists and family medicine physicians participated in this study.
We studied the likelihood physicians would discharge 12 hypothetical patients from their practices, and whether they had actually discharged such patients. The effect of demographic data on the number of scenarios in which patients were likely to be discharged, and the number of patients actually discharged were analyzed via ANOVA and multiple logistic regression analysis. Of 977 surveys received by subjects, 526 (54%) were completed and returned. A majority of respondents were willing to discharge patients in 5 of 12 hypothetical scenarios. Eighty-five percent had actually discharged at least one patient from their practices. Most respondents (71%) had discharged 10 or fewer patients, but 14% had discharged 11 to 200 patients. Respondents who were in private practice (p < 0.000001) were more likely to discharge both hypothetical and actual patients from their practices. Older physicians (> or =48 years old) were more likely to discharge actual patients from their practices (p = 0.005) as were physicians practicing in rural settings (p = 0.003).
Most physicians in our sample were willing to discharge actual and hypothetical patients from their practices. This tendency may have significant implications for the initiation of pay-for-performance programs. Physicians should be educated about the importance of the patient-physician relationship and their fiduciary obligations to the patient.
关于影响医生做出让患者不再在其诊所就诊决定的因素，现有数据较少。本研究旨在探讨普通内科医生和家庭医学医生在让患者不再在其诊所就诊方面的态度和经历。
采用横断面邮寄调查。
1000名普通内科医生和家庭医学医生参与了本研究。
我们研究了医生让12名假设患者不再在其诊所就诊的可能性，以及他们是否实际让此类患者不再就诊。通过方差分析和多元逻辑回归分析，研究了人口统计学数据对可能让患者不再就诊的情景数量以及实际让患者不再就诊数量的影响。在收到的977份调查问卷中，526份（54%）完成并返回。大多数受访者愿意在12种假设情景中的5种情景下让患者不再就诊。85%的受访者实际上已让至少一名患者不再在其诊所就诊。大多数受访者（71%）让10名或更少患者不再就诊，但14%的受访者让11至200名患者不再就诊。在私人诊所工作的受访者（p < 0.000001）更有可能让假设和实际患者不再在其诊所就诊。年龄较大的医生（≥48岁）（p = 0.005）以及在农村地区执业的医生（p = 0.003）更有可能让实际患者不再在其诊所就诊。
我们样本中的大多数医生愿意让实际和假设患者不再在其诊所就诊。这种倾向可能对绩效薪酬计划的启动产生重大影响。应让医生了解医患关系的重要性以及他们对患者的信托义务。
