Tompkins R K, Wood R W, Wolcott B W, Walsh B T
Med Care. 1977 Dec;15(12):991-1003. doi: 10.1097/00005650-197712000-00003.
The medical management of patients with acute respiratory illnesses was analyzed at two different clinics during a 14- to 21-month period. Patients received care from either physicians or physician-supervised physician's assistants (PA). The PAs used respiratory illness clinical algorithms to guide their choice of diagnostic tests and treatment. Illness outcome, patient satisfaction, and medical care cost data were obtained for all patients approximately two weeks after the index illness. Despite significant differences in patient population characteristics, illness outcomes were similar, regardless of the provider's educational background. Medical care costs, however, were highest for the physician's patients. For all patients, diagnostic tests contributed about one-third of the total direct costs, mainly because of chest x-ray and throat culture use. Sixty to eighty per cent of medication costs were due to nonprescription drugs used principally for symptom relief. The data demonstrate that the medical care delivered by these physician's assistants was as effective and less costly than the care provided by physicians. Reducing chest x-ray and throat culture use would have a significant economic impact, without adversely affecting medical care effectiveness.
在14至21个月的时间段内，对两家不同诊所中急性呼吸道疾病患者的医疗管理情况进行了分析。患者接受的治疗来自医生或由医生监督的医师助理（PA）。医师助理使用呼吸道疾病临床算法来指导他们对诊断测试和治疗方法的选择。在索引疾病发生约两周后，获取了所有患者的疾病转归、患者满意度和医疗费用数据。尽管患者群体特征存在显著差异，但无论提供者的教育背景如何，疾病转归都是相似的。然而，医生治疗的患者医疗费用最高。对于所有患者来说，诊断测试约占总直接成本的三分之一，主要原因是使用了胸部X光和咽喉培养。60%至80%的药物成本是由于主要用于缓解症状的非处方药。数据表明，这些医师助理提供的医疗服务与医生提供的服务一样有效，但成本更低。减少胸部X光和咽喉培养的使用将产生重大的经济影响，且不会对医疗效果产生不利影响。
