Rodriguez Hector P, Marsden Peter V, Landon Bruce E, Wilson Ira B, Cleary Paul D
University of Washington, Seattle, USA.
Med Care Res Rev. 2008 Feb;65(1):88-113. doi: 10.1177/1077558707310258.
Compared to single-clinician care, care provided by multiple clinicians might result in higher-quality care, especially if some of them have condition-specific expertise and complementary knowledge, skills, and roles. Individual physician continuity, which has been shown to be associated with care quality, necessarily decreases when care is provided by multiple clinicians. This study uses data from the HIV Cost and Services Utilization Study to assess the effect of care team composition on the quality of HIV care. In adjusted analyses, care teams composed of three or more clinicians were associated with more consistent prescribing of pneumocystis carinii pneumonia prophylaxis when medically indicated ( p < .01). Patients with multiple physicians generally reported worse care coordination, however, and had more inappropriate use of emergency services. These findings indicate both advantages and disadvantages to having multiple clinicians. More effort should be devoted to facilitating coordination when multiple clinicians provide care.
与单一临床医生提供的护理相比，由多名临床医生提供的护理可能会带来更高质量的护理，尤其是当其中一些临床医生具有特定疾病的专业知识以及互补的知识、技能和角色时。已证明与护理质量相关的个体医生连续性，在由多名临床医生提供护理时必然会降低。本研究使用来自“艾滋病成本与服务利用研究”的数据，以评估护理团队组成对艾滋病护理质量的影响。在调整分析中，由三名或更多临床医生组成的护理团队，在有医学指征时，与更一致地开具卡氏肺孢子虫肺炎预防药物相关（p < .01）。然而，有多名医生的患者通常报告护理协调较差，并且更多地不当使用急诊服务。这些发现表明有多名临床医生既有优点也有缺点。当多名临床医生提供护理时，应更加努力地促进协调。
