Wensing Michel, Van den Hombergh Pieter, Van Doremalen Jan, Grol Richard, Szecsenyi Joachim
Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands.
Health Policy. 2009 Jan;89(1):124-9. doi: 10.1016/j.healthpol.2008.05.008. Epub 2008 Jul 2.
This study aimed to explore the associations between chronic care organisation and physician workload in primary care.
Secondary analysis of observational data.
One hundred and forty general practices from 10 European countries.
The Chronic Care Model was used to specify measures for chronic care organisation in the practice. Practice size was operationalised as the number of yearly attending patients in the practice and physician workload as the mean number of physician working hours per 1000 yearly attending patients. Mixed linear regression analysis models were used.
Some aspects of chronic care organisation seemed to be associated with physician workload. After controlling for practice size and non-physician staff, none of these effects remained significant. Physicians worked, on average, 1.29h less per week for each additional 1000 patients yearly attending the practice. Each additional 0.1 full time equivalent assistance in the practice was associated with an increase of 1.6 physician working hours per week per 1000 patients.
Practice size rather than chronic care organisation determined physician workload. Larger practices might use physicians' time more efficiently compared to small practices, but reduced quality of care in larger practices could be an alternative interpretation of the findings.
本研究旨在探讨初级保健中慢性病护理组织与医生工作量之间的关联。
观察性数据的二次分析。
来自10个欧洲国家的140家普通诊所。
采用慢性病护理模型来明确诊所中慢性病护理组织的测量指标。诊所规模通过诊所每年就诊患者数量来衡量，医生工作量通过每1000名每年就诊患者的医生平均工作小时数来衡量。使用混合线性回归分析模型。
慢性病护理组织的某些方面似乎与医生工作量相关。在控制了诊所规模和非医生工作人员后，这些影响均不再显著。诊所每年每增加1000名就诊患者，医生平均每周工作时间减少1.29小时。诊所每增加0.1个全职等效助手，每1000名患者的医生每周工作时间增加1.6小时。
决定医生工作量的是诊所规模而非慢性病护理组织。与小诊所相比，大诊所可能更有效地利用医生时间，但大诊所护理质量下降可能是对研究结果的另一种解释。
