家庭医生与患者的关系以及初级和专科医疗保健的频繁就诊：一项基于德国人群的队列研究结果。

Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.

作者信息

Dinkel Andreas, Schneider Antonius, Schmutzer Gabriele, Brähler Elmar, Häuser Winfried

机构信息

Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.

出版信息

Patient Educ Couns. 2016 Jul;99(7):1213-1219. doi: 10.1016/j.pec.2016.02.009. Epub 2016 Feb 16.

DOI:10.1016/j.pec.2016.02.009

PMID:26924610

Abstract

OBJECTIVE

To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care.

METHODS

Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression.

RESULTS

Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists.

CONCLUSIONS

The quality of the family physician-patient relationship is not independently associated with frequent attendance.

PRACTICE IMPLICATIONS

Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance.

摘要

目的

探讨家庭医生与患者关系质量与基层及专科医疗保健频繁就诊之间的关联。

方法

对具有代表性的德国人群样本（N = 2266）进行横断面调查。使用医患关系问卷（PDRQ - 9）评估家庭医生与患者的关系。采用逻辑回归分析频繁就诊的决定因素。

结果

在多变量分析中，家庭医生频繁就诊与低收入（比值比[OR] 1.43，95%置信区间[CI] 1 .02 - 2.00）、无带薪工作(OR 1.58，CI 1.08 - 2.30)、心理困扰(OR 1.14，CI 1.07 - 1.22)、躯体症状(OR 1.07，CI 1.04 - 1.11)以及身体合并症(OR 1.54，CI 1.36 - 1.74)相关。在多变量分析中，专科医生频繁就诊与心理困扰(OR 1.12，CI 1.04 - 1.20)、躯体症状(OR 1.08，CI 1.04 - 1.11)以及身体合并症(OR 1.69，CI 1.48 - 1.93)相关。仅在单变量分析中，关系质量与频繁就诊相关。与家庭医生关系更强与减少与专科医生的接触无关。