1 Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA 2 Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington, USA 3 The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA 4 Blue Cross Blue Shield of Massachusetts, Boston, Massachusetts, USA.
Patient. 2009 Jun 1;2(2):95-103. doi: 10.2165/01312067-200902020-00005.
Concierge medical practice is a relatively new and somewhat controversial development in primary-care practice. These practices promise patients more personalized care and dedicated service, in exchange for an annual membership fee paid by patients. The experiences of patients using these practices remain largely undocumented.
To assess the experiences of patients in a concierge medicine practice compared with those in a general medicine practice.
Stratified random samples of patients empanelled to each of the four doctors who practice at both a general medicine and a concierge medicine practice separately situated at an academic medical center were drawn. Patients were eligible for the study if they had a visit with the physician between January and May 2006. The study questionnaire (Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey, supplemented with items from the Ambulatory Care Experiences Survey) was administered by mail to 100 general medicine patients per physician (n = 400) and all eligible concierge medicine patients (n = 201). Patients who completed the survey and affirmed the study physician as their primary-care physician formed the analytic sample (n = 344) that was used to compare the experiences of concierge medicine and general medicine patients. Models controlled for respondent characteristics and accounted for patient clustering within physicians using physician fixed effects.
Patients' experiences with organizational features of care, comprising care co-ordination (p < 0.01), access to care (p < 0.001) and interactions with office staff (p < 0.001), favored concierge medicine over general medicine practice. The quality of physician-patient interactions did not differ significantly between the two groups. However, the patients of the concierge medicine practice were more likely to report that their physician spends sufficient time in clinical encounters than patients of the general medicine practice (p < 0.003).
The results suggest patients of the concierge medicine practice experienced and reported enhanced service, greater access to care, and better care co-ordination than those of the general medicine practice. This suggests that further study to understand the etiology of these differences may be beneficial in enhancing patients' experience in traditional primary-care practices.
会员制医疗是初级保健实践中一种相对较新且颇具争议的发展。这些实践承诺为患者提供更个性化的护理和专属服务，作为交换，患者需向医生支付年费。然而，患者在使用这些实践中的体验在很大程度上仍未被记录。
评估在会员制医疗实践中患者的体验与在普通医疗实践中的体验有何不同。
在学术医疗中心的同一地点分别开展普通医疗和会员制医疗实践的四位医生中，抽取分层随机样本纳入每位医生的患者。如果患者在 2006 年 1 月至 5 月期间与医生有过一次就诊，他们就有资格参与这项研究。研究问卷（医疗保健提供者和系统患者评估量表临床医生和小组调查部分，补充了门诊护理体验调查的项目）通过邮件发送给每位医生的 100 名普通医疗患者（n=400）和所有合格的会员制医疗患者（n=201）。完成调查并确认研究医生为其初级保健医生的患者构成了分析样本（n=344），用于比较会员制医疗和普通医疗患者的体验。模型控制了受访者特征，并使用医生固定效应考虑了患者在医生中的聚类。
患者对医疗保健组织特征的体验，包括医疗协调（p<0.01）、获得医疗保健的机会（p<0.001）和与办公室工作人员的互动（p<0.001），更倾向于会员制医疗而不是普通医疗实践。两组患者在医患互动质量方面没有显著差异。然而，会员制医疗实践的患者更有可能报告他们的医生在临床就诊中花费了足够的时间，而普通医疗实践的患者则不然（p<0.003）。
结果表明，会员制医疗实践的患者体验到并报告了比普通医疗实践的患者更好的服务、更多的医疗机会和更好的医疗协调。这表明，进一步研究理解这些差异的病因可能有助于提高传统初级保健实践中患者的体验。
