Doering Nora, Maarse Hans
Department of Health Services Research, School for Public Health and Primary Care (Caphri) of the Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Health Expect. 2015 Dec;18(6):2174-82. doi: 10.1111/hex.12187. Epub 2014 Mar 27.
Patients barely use publicly available quality information for making a decision concerning secondary health care, but instead rely on information coming from their general practitioner (GP). An intermediate role of GPs has been suggested concerning the use of publicly available quality information. The aim of the study is to quantify and explore GPs' use of publicly available quality information when referring patients or suggesting secondary health-care provider to them.
In this cross-sectional study, an invitation to an electronic questionnaire was sent to 858 GPs in the south of the Netherlands. GPs were asked about their use of and perception towards publicly available quality information through closed-ended and open-ended questions. Differences among subgroups were tested for significance using Pearson's chi-square tests.
The majority of respondents (89.5%) never or rarely use publicly available quality information. They perceive them as invalid and unreliable. Distance to the hospital, prior experiences and personal contacts with specialists guide them when advising and referring. Almost 90% of respondents never or rarely suggest quality information as support for decision making to their patients. No significant differences between subgroups were observed.
This study is among the firsts exploring and quantifying GPs' use of publicly available quality information. The results suggest that publicly available quality information appears in its current format and application not useful for GPs. GPs have to be aware of their influential role in patients' decision making and possibly have to take more responsibility in guiding them through the jungle of quality information.
患者在决定二级医疗保健时几乎不使用公开可用的质量信息，而是依赖于他们的全科医生（GP）提供的信息。有人提出全科医生在使用公开可用的质量信息方面可起到中间作用。本研究的目的是量化并探索全科医生在为患者转诊或推荐二级医疗保健提供者时对公开可用质量信息的使用情况。
在这项横断面研究中，向荷兰南部的858名全科医生发送了电子问卷邀请。通过封闭式和开放式问题询问全科医生对公开可用质量信息的使用情况和看法。使用Pearson卡方检验来检验亚组之间差异的显著性。
大多数受访者（89.5%）从不或很少使用公开可用的质量信息。他们认为这些信息无效且不可靠。在提供建议和转诊时，到医院的距离、既往经历以及与专家的个人联系会对他们产生影响。近90%的受访者从不或很少向患者推荐质量信息作为决策支持。未观察到亚组之间存在显著差异。
本研究是首批探索和量化全科医生对公开可用质量信息使用情况的研究之一。结果表明，以目前的形式和应用方式，公开可用的质量信息对全科医生似乎并无用处。全科医生必须意识到他们在患者决策中的影响力，并且可能需要承担更多责任，引导患者穿越质量信息的丛林。
