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挪威医疗保健的生态:广泛使用全科医生未必能使患者不进医院。

The Ecology of Medical Care in Norway: Wide Use of General Practitioners may not Necessarily Keep Patients out of Hospitals.

作者信息

Hansen Anne Helen, Halvorsen Peder A, Forde Olav Helge

机构信息

National Centre for Integrated Care and Telemedicine, University Hospital of Northern Norway , Tromso.

National Centre of Rural Medicine and General Practice Research Unit, Department of Community Medicine, University of Tromsø

出版信息

J Public Health Res. 2012 Jul 31;1(2):177-83. doi: 10.4081/jphr.2012.e28. eCollection 2012 Jun 15.

Abstract

BACKGROUND

Our aim was to investigate the pattern of self reported symptoms and utilisation of health care services in Norway.

DESIGN AND METHODS

With data from the cross-sectional Tromsø Study (2007-8), we estimated population proportions reporting symptoms and use of seven different health services. By logistic regression we estimated differences according to age and gender.

RESULTS

In this study 12,982 persons aged 30-87 years participated, constituting 65.7% of those invited. More than 900/1000 reported symptoms or health problems in a year as well as in a month, and 214/1000 and 816/1000 visited a general practitioner once or more in a month and a year, respectively. The corresponding figures were 91/1000 and 421/1000 for specialist outpatient visits, and 14/1000 and 116/1000 for hospitalisations. Physiotherapists were visited by 210/1000, chiropractors by 76/1000, complementary and alternative medical providers by 127/1000, and dentists by 692/1000 in a year. Women used most health care services more than men, but genders used hospitalisations and chiropractors equally. Utilisation of all services increased with age, except chiropractors, dentists and complementary and alternative medical providers.

CONCLUSIONS

Almost the entire population reported health related problems during the previous year, and most residents visited a general practitioner. Yet there were high rates of inpatient and outpatient specialist utilisation. We suggest that wide use of general practitioners may not necessarily keep patients out of specialist care and hospitals.

ACKNOWLEDGMENTS

the authors would like to thank Tor Anvik for a significant contribution in developing the idea for the study, Tom Wilsgård for useful discussions about the statistical analyses and Jarl-Stian Olsen for graphic design of the figures. They would also thank the people of Tromsø and The Tromsø Study for giving data to this study. Northern Norway Regional Health Authority and The University of Tromsø funded this research.

摘要

背景

我们的目的是调查挪威自我报告症状的模式以及医疗服务的使用情况。

设计与方法

利用来自特罗姆瑟横断面研究(2007 - 2008年)的数据,我们估计了报告症状和使用七种不同医疗服务的人群比例。通过逻辑回归,我们估计了年龄和性别的差异。

结果

在本研究中,12982名年龄在30 - 87岁的人参与其中,占受邀者的65.7%。超过900/1000的人在一年以及一个月内报告有症状或健康问题,214/1000和816/1000的人分别在一个月和一年内至少看一次全科医生。专科门诊就诊的相应数字分别为91/1000和421/1000,住院治疗的相应数字分别为14/1000和116/1000。一年中有210/1000的人看过物理治疗师,76/1000的人看过脊椎按摩师,127/1000的人看过补充和替代医学提供者,692/1000的人看过牙医。女性比男性更多地使用大多数医疗服务,但两性使用住院治疗和脊椎按摩师服务的情况相同。除脊椎按摩师、牙医以及补充和替代医学提供者外,所有服务的使用率都随年龄增长而增加。

结论

几乎整个人口在前一年都报告了与健康相关的问题,并且大多数居民都看过全科医生。然而,住院和专科门诊的使用率仍然很高。我们认为广泛使用全科医生不一定能使患者避免接受专科护理和住院治疗。

致谢

作者感谢托尔·安维克在研究想法的提出上做出的重大贡献,感谢汤姆·威尔斯加德在统计分析方面进行的有益讨论,感谢贾尔 - 斯蒂安·奥尔森对图表的平面设计。他们还要感谢特罗姆瑟的民众以及特罗姆瑟研究为本研究提供数据。挪威北部地区卫生局和特罗姆瑟大学资助了这项研究。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92b8/4140360/94d74a9c64b6/jphr-2012-2-e28-g001.jpg

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