Ventelou Bruno, Rolland Sophie, Verger Pierre
Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France.
Healthc Policy. 2010 May;5(4):58-68.
The relationship between the length of GP consultation in primary care and drug prescribing practices is still a subject for debate. Patients' morbidity, generating both very long consultation times and large volumes of prescriptions, may mask an underlying substitution among GPs regarding the length of time they offer to patients versus the alternative of prescribing pharmaceuticals. We propose to pursue the debate by analyzing the results of a case vignette, submitted to 1,900 GPs, in which patient morbidity is controlled for by definition. In this case - a hypothetical patient suffering from mild depression - we observe the choice between three types of treatment strategy: psychotherapy, drug therapy and a combination of the two. We observe that the GPs with the highest consultation rates were twice as likely to adopt the drug therapy option as their counterparts with lower rates of consultation. Moreover, for more than 50% of drug prescriptions, the medical decisions contradict clinical practice guidelines.
基层医疗中全科医生诊疗时间长度与药物处方行为之间的关系仍是一个有待辩论的话题。患者的发病率既导致了很长的诊疗时间，也产生了大量的处方，这可能掩盖了全科医生在为患者提供诊疗时间与开处方这两种选择之间的潜在替代关系。我们建议通过分析一个提交给1900名全科医生的病例 vignette的结果来继续这场辩论，在这个病例 vignette中，患者发病率已按定义得到控制。在这个案例中——一名患有轻度抑郁症的假设患者——我们观察了三种治疗策略之间的选择：心理治疗、药物治疗以及两者结合。我们发现，诊疗率最高的全科医生选择药物治疗方案的可能性是诊疗率较低的同行的两倍。此外，超过50%的药物处方，其医疗决策与临床实践指南相悖。
