Macpherson A K, Kramer M S, Ducharme F M, Yang H, Bélanger F P
Pediatric Outcomes Research Team, Division of Pediatric Medicine, Faculty of Medicine, University of Toronto Toronto, Ontario;
Paediatr Child Health. 2001 Jul;6(6):341-6. doi: 10.1093/pch/6.6.341.
Use of multiple care providers is known to be associated with poor continuity of care.
To estimate the prevalence of and identify risk factors for doctor shopping by parents of children with common acute illnesses seen in the emergency department (ED) of a children's hospital.
ED at the Montreal Children's Hospital (MCH), Montreal, Quebec.
Doctor shopping was defined as visiting three or more different care sites (the MCH ED, other EDs, outpatient clinics or private offices) for a single illness episode, including all visits occurring within successive 72 h periods up to a maximum of 15 days before and after an ED visit from April 1995 to March 1996. Logistic regression was used to compare characteristics of illness episodes with doctor shopping versus those without.
Of the total 40,150 visits during the study period, doctor shopping was observed in 18% of the visits. The risk of doctor shopping was positively associated with an initial visit at other EDs (odds ratio [OR] 9.08, 95% CI 7.16 to 11.52), outpatient clinics (OR 4.47, 95% CI 3.71 to 5.37) or private offices (OR 1.71, 95% CI 1.48 to 1.96) versus those who visited the MCH ED first. The risk did not differ according to whether a paediatrician versus a general practitioner saw the child during the initial visit (OR 0.99, 95% CI 0.86 to 1.15). Some diagnoses (the reference category was upper respiratory infection), including urinary tract infection (OR 3.31, 95% CI 2.58 to 4.23) and gastroenteritis (OR 1.59, 95% CI 1.35 to 1.88), were associated with an increased risk of doctor shopping, while asthma was associated with a reduced risk (OR 0.71, 95% CI 0.60 to 0.86).
Doctor shopping is common among parents of children with acute illnesses. Parents of children who were seen in the MCH ED first were less likely to doctor shop, perhaps because the parents were more confident about the advice and treatment received. Further research should investigate the underlying reasons for doctor shopping, eg, services other than an ED were not available and parents' perceptions of the quality of health services.
已知使用多个医疗服务提供者与医疗连续性差有关。
估计儿童医院急诊科中患有常见急性疾病儿童的家长“医生购物”行为的患病率，并确定其风险因素。
魁北克省蒙特利尔市蒙特利尔儿童医院急诊科。
“医生购物”定义为针对单次疾病发作就诊于三个或更多不同的医疗机构（蒙特利尔儿童医院急诊科、其他急诊科、门诊诊所或私人诊所），包括在1995年4月至1996年3月期间，在急诊科就诊前后连续72小时内（最长15天）的所有就诊。采用逻辑回归比较有“医生购物”行为与无此行为的疾病发作特征。
在研究期间的总共40150次就诊中，18%的就诊存在“医生购物”行为。与首先就诊于蒙特利尔儿童医院急诊科的患者相比，在其他急诊科（优势比[OR]9.08，95%可信区间7.16至11.52）、门诊诊所（OR 4.47，95%可信区间3.71至5.37）或私人诊所（OR 1.71，95%可信区间1.48至1.96）首次就诊的患者出现“医生购物”行为的风险更高。首次就诊时由儿科医生还是全科医生诊治患儿，风险无差异（OR 0.99，95%可信区间0.86至1.15）。某些诊断（参考类别为上呼吸道感染），包括尿路感染（OR 3.31，95%可信区间2.58至4.23）和肠胃炎（OR 1.59，95%可信区间1.35至1.88），与“医生购物”风险增加相关，而哮喘与风险降低相关（OR 0.7
