挪威本土医生和从事非工作时间工作的移民医生的临床实践模式：一项基于登记处的观察性研究。

Clinical practice patterns among native and immigrant doctors doing out-of-hours work in Norway: a registry-based observational study.

作者信息

Sandvik Hogne, Hunskaar Steinar, Diaz Esperanza

机构信息

National Centre for Emergency Primary Health Care, Uni Health, Uni Research, Bergen, Norway.

出版信息

BMJ Open. 2012 Jul 12;2(4). doi: 10.1136/bmjopen-2012-001153. Print 2012.

DOI:10.1136/bmjopen-2012-001153

PMID:22798255

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3400071/

Abstract

OBJECTIVES

To evaluate whether immigrant and native Norwegian doctors differ in their practice patterns.

DESIGN

Observational study.

SETTING

Out-of-hours (OOH) emergency primary healthcare in Norway, 2008.

PARTICIPANTS

All primary care physicians doing OOH work, altogether 4165 physicians.

MAIN OUTCOME MEASURES

Number of patient contacts per doctor. Use of laboratory tests, minor surgery, sickness certification and length of consultations. Use of diagnoses related to psychiatric and sexual health. Choice of management strategy with psychiatric patients (psychotherapy or hospitalisation).

RESULTS

21.4% of the physicians were immigrants, and they had 30.6% of the patient contacts. Immigrant doctors from Asia, Africa and Latin America had most patient contacts, 633 (95% CI 549 to 716), while native Norwegian doctors had 306 (95% CI 288 to 325). In multivariate analyses, immigrant physicians did not differ significantly from native Norwegians regarding use of laboratory tests, minor surgery or length of consultations, but immigrant doctors wrote more sickness certificates, OR 1.75 (95% CI 1.24 to 2.47) for immigrant doctors from Europe, North America and Oceania versus native Norwegian doctors and OR 1.56 (95% CI 1.15 to 2.11) for immigrant doctors from Asia, Africa and Latin America versus native Norwegians. Immigrant physicians from Europe, North America and Oceania used more diagnoses related to pregnancy, family planning and female genitals, OR 1.55 (95% CI 1.11 to 2.16), versus native Norwegian physicians. Immigrant doctors from Asia, Africa and Latin America used less psychiatric diagnoses, OR 0.71 (95% CI 0.53 to 0.95), versus native Norwegian doctors but did not differ significantly in their management of recognised psychiatric illness.

CONCLUSIONS

Immigrant doctors make an important contribution to OOH emergency primary healthcare in Norway. The authors found only modest evidence that their clinical practice patterns are different from that of native Norwegian doctors.

摘要

目的

评估挪威移民医生与本土医生的执业模式是否存在差异。

设计

观察性研究。

背景

2008年挪威非工作时间（OOH）的急诊初级医疗保健。

参与者

所有从事非工作时间工作的初级保健医生，共4165名医生。

主要观察指标

每位医生的患者接触次数。实验室检查、小手术、疾病证明的使用情况及会诊时长。与精神和性健康相关的诊断使用情况。对精神疾病患者管理策略的选择（心理治疗或住院治疗）。

结果

21.4%的医生为移民医生，他们负责30.6%的患者接触。来自亚洲、非洲和拉丁美洲的移民医生患者接触次数最多，为633次（95%置信区间549至716），而挪威本土医生为306次（95%置信区间288至325）。在多变量分析中，移民医生在实验室检查、小手术或会诊时长的使用方面与挪威本土医生无显著差异，但移民医生开具的疾病证明更多，来自欧洲、北美和大洋洲的移民医生与挪威本土医生相比，比值比为1.75（95%置信区间1.24至2.47），来自亚洲、非洲和拉丁美洲的移民医生与挪威本土医生相比，比值比为1.56（95%置信区间1.15至2.11）。来自欧洲、北美和大洋洲的移民医生使用更多与妊娠、计划生育和女性生殖器相关的诊断，与挪威本土医生相比，比值比为1.55（95%置信区间1.11至2.16）。来自亚洲、非洲和拉丁美洲的移民医生使用的精神疾病诊断较少，与挪威本土医生相比，比值比为0.71（95%置信区间0.53至0.95），但在已确诊精神疾病的管理方面无显著差异。