Kuyvenhoven M M, Pieters H M, Jacobs H M, Touw-Otten F W, Spreeuwenberg C
Department of General Practice, University of Utrecht, The Netherlands.
Qual Assur Health Care. 1990;2(2):171-9. doi: 10.1093/intqhc/2.2.171.
The present study relates to three aspects of quality of care in general practice: attention paid to somatic aspects, patient orientation and risk of unnecessary harm. Quality of care had been measured by (a) a written simulation of patient-doctor encounters, which includes five patients and (b) rating procedures. The study has been carried out in two steps. Firstly several aspects of peer consultation have been investigated in a group of 184 doctors (response rate: 83%), who had their vocational training in the department of General Practice of the University of Utrecht. One third of the GPs consulted colleagues frequently and continued to do so for long periods, dealing systematically with a variety of problems, one third did so infrequently or unsystematically, and one third did little or no consulting at all. A relationship was found between the type of practice and consulting behaviour: 20% of those who practice alone never consulted peers, whereas those in group practices and health centres are accustomed to do so regularly. Secondly, 49 doctors were selected from the 184 mentioned above. The 49 did not differ from the remainder in several relevant aspects such as practice setting, subscription to medical journals, etc. Peer consultation seems to have a direct relationship with the quality of attention paid to somatic aspects; GPs who do not consult among peers in any way display a lower quality of attention to somatic aspects in comparison to the others. In this study these GPs are all solo physicians.(ABSTRACT TRUNCATED AT 250 WORDS)
对躯体问题的关注、以患者为导向以及不必要伤害的风险。医疗服务质量通过以下方式衡量：（a）医患交流的书面模拟，其中包括五名患者；（b）评分程序。该研究分两步进行。首先，在184名医生（回复率：83%）中调查了同行咨询的几个方面，这些医生在乌得勒支大学全科医疗系接受过职业培训。三分之一的全科医生经常咨询同事，且长期如此，系统地处理各种问题；三分之一的医生咨询较少或不系统；三分之一的医生几乎不咨询或根本不咨询。研究发现执业类型与咨询行为之间存在关联：独自执业的医生中有20%从不咨询同行，而在团体执业和健康中心工作的医生则习惯于定期咨询。其次，从上述184名医生中挑选出49名。这49名医生在执业环境、订阅医学期刊等几个相关方面与其余医生没有差异。同行咨询似乎与对躯体问题的关注质量直接相关；与其他医生相比，从不与同行咨询的全科医生对躯体问题的关注质量较低。在本研究中，这些全科医生均为独自执业医生。（摘要截断于250字）
