Kirchhoff Anne C, Hart Gary, Campbell Eric G
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah; Cancer Control and Population Sciences, Huntsman Cancer Institute, Salt Lake City, Utah.
J Rural Health. 2014 Summer;30(3):235-43. doi: 10.1111/jrh.12067. Epub 2014 Feb 16.
We evaluated whether primary care physicians (PCPs) from urban and rural practices differ on attitudes and behaviors related to quality improvement (QI) activities, patient relationships, and professionalism/self-regulation.
Data from a national survey that assessed physician attitudes and behaviors based on the Physician Charter on Medical Professionalism were used. Of the 1,891 survey respondents, N = 840 were PCPs (n = 274 family medicine (response rate = 67.5%); n = 257 general internal medicine (60.8%); and n = 309 pediatricians (72.7%)). Using Rural-Urban Commuting Area (RUCA) codes, PCPs were classified as urban and rural according to their practice ZIP code.
A total of n = 691 physicians were urban and n = 127 rural. Attitudes regarding participating in QI did not differ by practice location; however, rural PCPs were more likely to have reviewed an other physician's records for QI than urban PCPs (65.6% vs 48.0%, P < .001). Rural physicians were more likely to agree that physicians should talk with their patients about the cost of care than urban PCPs (40.5% vs 29.2%, P = .02). While all PCPs endorsed attitudes regarding the importance of professional behaviors (eg, reporting impaired/incompetent colleagues, disclosing medical errors) at generally similar levels, their behaviors differed. More rural physicians had a personal knowledge of an impaired/incompetent physician than urban physicians (20.7% vs 12.7%, P = .02).
PCPs from rural and urban areas share similar attitudes regarding the importance of participating in QI and fulfilling professional responsibilities. However, certain behaviors (eg, knowledge of impaired colleagues) do differ. These results should be confirmed in larger studies of rural PCPs.
我们评估了来自城市和农村医疗机构的基层医疗医生（PCP）在与质量改进（QI）活动、医患关系以及职业素养/自我监管相关的态度和行为上是否存在差异。
使用了一项全国性调查的数据，该调查基于《医学职业宪章》评估医生的态度和行为。在1891名调查受访者中，N = 840名是基层医疗医生（n = 274名家庭医学医生（回复率 = 67.5%）；n = 257名普通内科医生（60.8%）；n = 309名儿科医生（72.7%））。根据城乡通勤区（RUCA）代码，基层医疗医生根据其执业邮政编码被分为城市和农村两类。
共有n = 691名医生为城市医生，n = 127名医生为农村医生。关于参与质量改进的态度在不同执业地点并无差异；然而，农村基层医疗医生比城市基层医疗医生更有可能为了质量改进而查阅其他医生的记录（65.6%对48.0%，P <.001）。农村医生比城市基层医疗医生更有可能同意医生应该与患者谈论医疗费用（40.5%对29.2%，P =.02）。虽然所有基层医疗医生对职业行为的重要性（例如，举报有问题/不称职的同事、披露医疗差错）的态度认可度大致相似，但他们的行为却有所不同。了解有问题/不称职医生情况的农村医生比城市医生更多（20.7%对12.7%，P =.02）。
来自农村和城市地区的基层医疗医生在参与质量改进和履行职业责任的重要性方面态度相似。然而，某些行为（例如，了解有问题的同事）确实存在差异。这些结果应在针对农村基层医疗医生的更大规模研究中得到证实。
