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基层医疗单人执业诊所:同质化还是异质化?

Primary healthcare solo practices: homogeneous or heterogeneous?

作者信息

Pineault Raynald, Borgès Da Silva Roxane, Provost Sylvie, Beaulieu Marie-Dominique, Boivin Antoine, Couture Audrey, Prud'homme Alexandre

机构信息

Direction de Santé Publique de l'Agence de la Santé et des Services Sociaux de Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3 ; Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Québec, QC, Canada G1V 5B3 ; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, 3480 rue Saint-Urbain, Hôtel-Dieu (Pavillon Masson), Montréal, QC, Canada H2W 1T8.

Direction de Santé Publique de l'Agence de la Santé et des Services Sociaux de Montréal, 1301 rue Sherbrooke Est, Montréal, QC, Canada H2L 1M3 ; Institut National de Santé Publique du Québec, 945 Avenue Wolfe, Québec, QC, Canada G1V 5B3 ; Faculté des Sciences Infirmières, Université de Montréal (Pavillon Marguerite d'Youville), CP 6128, Succursale Centre-ville, Montréal, QC, Canada H3C 3J7.

出版信息

Int J Family Med. 2014;2014:373725. doi: 10.1155/2014/373725. Epub 2014 Jan 12.

Abstract

Introduction. Solo practices have generally been viewed as forming a homogeneous group. However, they may differ on many characteristics. The objective of this paper is to identify different forms of solo practice and to determine the extent to which they are associated with patient experience of care. Methods. Two surveys were carried out in two regions of Quebec in 2010: a telephone survey of 9180 respondents from the general population and a postal survey of 606 primary healthcare (PHC) practices. Data from the two surveys were linked through the respondent's usual source of care. A taxonomy of solo practices was constructed (n = 213), using cluster analysis techniques. Bivariate and multilevel analyses were used to determine the relationship of the taxonomy with patient experience of care. Results. Four models were derived from the taxonomy. Practices in the "resourceful networked" model contrast with those of the "resourceless isolated" model to the extent that the experience of care reported by their patients is more favorable. Conclusion. Solo practice is not a homogeneous group. The four models identified have different organizational features and their patients' experience of care also differs. Some models seem to offer a better organizational potential in the context of current reforms.

摘要

引言。个体执业通常被视为一个同质化的群体。然而,它们在许多特征上可能存在差异。本文的目的是识别个体执业的不同形式,并确定它们与患者护理体验的关联程度。方法。2010年在魁北克的两个地区进行了两项调查:对9180名普通人群进行电话调查,对606家初级医疗保健(PHC)机构进行邮政调查。两项调查的数据通过受访者通常的医疗服务来源进行关联。使用聚类分析技术构建了个体执业的分类法(n = 213)。采用双变量和多层次分析来确定分类法与患者护理体验之间的关系。结果。从分类法中得出了四种模式。“资源丰富且网络化”模式的机构与“资源匮乏且孤立”模式的机构形成对比,前者患者报告的护理体验更有利。结论。个体执业并非一个同质化的群体。所识别的四种模式具有不同的组织特征,其患者的护理体验也有所不同。在当前改革背景下,一些模式似乎具有更好的组织潜力。

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