Hogg William, Dahrouge Simone, Russell Grant, Tuna Meltem, Geneau Robert, Muldoon Laura, Kristjansson Elizabeth, Johnston Sharon
Open Med. 2009;3(3):e165-73. Epub 2009 Sep 1.
Lifestyle behaviours have significant health and economic consequences. Primary care providers play an important role in promoting healthy behaviours. We compared the performance of primary care models in delivering health promotion and identified practice factors associated with its delivery.
Surveys were conducted in 137 randomly selected primary care practices in 4 primary care models in Ontario, Canada: 35 community health centres, 35 fee-for-service practices, 35 family health networks and 32 health service organizations. A total of 4861 adult patients who were visiting their family practice participated in the study. Qualitative nested case studies were also conducted at 2 practices per model. A 7-item question was used to evaluate health promotion. The main outcome was whether at least 1 of the 7 health promotion items was discussed at the survey visit. Multilevel logistic regressions were used to compare the models and determine performance-related practice factors.
The rate of health promotion was significantly higher in community health centres than in the other models (the unadjusted difference ranged between 8% and 13%). This finding persisted after controlling for patient and family physician profiles. Factors independently positively associated with health promotion were as follows: reason for visit (for a general checkup: adjusted odds ratio [AOR] 3.34, 95% confidence interval [CI] 2.81-3.97; for care for a chronic disease: AOR 2.03, 95% CI 1.69-2.43), patients having and seeing their own provider (for those not: AOR 0.58, 95% CI 0.43-0.78), number of nurses in the practice (AOR 1.07, 95% CI 1.02-1.12), percentage of female family physicians (AOR 1.38, 95% CI 1.15-1.66), smaller physician panel size (AOR 0.92, 95% CI 0.85-1.01) and longer booking interval (AOR 1.03, 95% CI 1.01-1.04). Providers in interdisciplinary practices viewed health promotion as an integral part of primary care, whereas other providers emphasized the role of relational continuity in effective health promotion.
We have identified several attributes associated with health promotion delivery. These results may assist practice managers and policy-makers in modifying practice attributes to improve health promotion in primary care.
生活方式行为会产生重大的健康和经济后果。初级保健提供者在促进健康行为方面发挥着重要作用。我们比较了初级保健模式在提供健康促进方面的表现，并确定了与其提供相关的实践因素。
在加拿大安大略省的4种初级保健模式中的137个随机选择的初级保健机构中进行了调查：35个社区健康中心、35个按服务收费的机构、35个家庭健康网络和32个健康服务组织。共有4861名就诊于其家庭医生诊所的成年患者参与了该研究。每个模式还在2个机构中进行了定性嵌套案例研究。使用一个7项问题来评估健康促进情况。主要结果是在调查就诊时是否讨论了7项健康促进项目中的至少1项。使用多水平逻辑回归来比较这些模式并确定与表现相关的实践因素。
社区健康中心的健康促进率显著高于其他模式（未调整差异在8%至13%之间）。在控制了患者和家庭医生特征后，这一发现仍然存在。与健康促进独立正相关的因素如下：就诊原因（进行全面体检：调整后的优势比[AOR]为3.34，95%置信区间[CI]为2.81 - 3.97；治疗慢性病：AOR为2.03，95%CI为1.69 - 2.43）、患者有并看自己的医生（没有的患者：AOR为0.58，95%CI为0.43 - 0.78）、机构中的护士数量（AOR为1.07，95%CI为1.02 - 1.12）、女性家庭医生的比例（AOR为1.38，95%CI为1.15 - 1.66）、较小的医生诊疗小组规模（AOR为0.92，95%CI为0.85 - 1.01）和较长的预约间隔（AOR为1.03，95%CI为1.01 - 1.04）。跨学科实践中的提供者将健康促进视为初级保健的一个组成部分，而其他提供者则强调关系连续性在有效的健康促进中的作用。
我们确定了几个与提供健康促进相关的属性。这些结果可能有助于实践管理者和政策制定者调整实践属性，以改善初级保健中的健康促进。
