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德国传统全科医生与自然疗法全科医生的执业模式差异。

Differences between Practice Patterns of Conventional and Naturopathic GPs in Germany.

作者信息

Laux Gunter, Musselmann Berthold, Kiel Marion, Szecsenyi Joachim, Joos Stefanie

机构信息

University Hospital Heidelberg, Department of General Practice and Health Services Research, Heidelberg, Germany.

出版信息

PLoS One. 2016 Oct 3;11(10):e0163519. doi: 10.1371/journal.pone.0163519. eCollection 2016.

Abstract

BACKGROUND

Limited evidence exists whether practice patterns of general practitioners (GPs) who have additionally completed training in naturopathy are different from those of conventional GPs. We aimed to assess and compare practice patterns of GPs in conventional and naturopathic GPs.

METHODS

Routine data from 41 GPs (31 with and 11 without additional qualification in NP, respectively) and 180,789 patients, drawn from the CONTinuous morbidity registration Epidemiologic NeTwork (CONTENT)-registry and collected between 2009 and 2014, were used. To assess practice patterns determinants of (non-)phytopharmaceutical prescriptions, referrals and hospitalizations were analyzed using mixed-effects Poisson regression models. As explanatory variables, the qualification of the GP in NM, the age group and sex of the patient, as well as bivariate interactions between these variables were considered.

RESULTS

GPs additionally qualified in naturopathy exhibited higher rates of phytopharmaceutical prescriptions (p<0.034; independent effect) compared to conventional GPs. This association was not observed with respect to non-phytopharmaceutical prescriptions. However, interaction effects between qualification and age group as well as sex were present with respect to both phytopharmaceutical and non-phytopharmaceutical prescriptions (all p<0.001). No further independent association existed between qualification and either referral rates or hospitalization rates, but again interactions between qualification and age group and sex (only referrals) were statistically significant (all p<0.0001).

CONCLUSION

The results show that the rate of phyto-pharmaceutical prescriptions are generally higher when the GP has an additional qualification in naturopathy. Further differences in practice patterns between conventional and naturopathy GPs could be subject to certain age groups and sex. However, the magnitude of these differences seem to be rather small.

摘要

背景

关于接受过自然疗法额外培训的全科医生(GP)的执业模式是否与传统全科医生不同,现有证据有限。我们旨在评估和比较传统全科医生与自然疗法全科医生的执业模式。

方法

使用从连续发病登记流行病学网络(CONTENT)登记处提取的、在2009年至2014年期间收集的41名全科医生(分别为31名具有自然疗法额外资质和11名没有该额外资质)和180789名患者的常规数据。为了评估执业模式,使用混合效应泊松回归模型分析(非)植物药处方、转诊和住院的决定因素。作为解释变量,考虑了全科医生在自然疗法方面的资质、患者的年龄组和性别,以及这些变量之间的双变量交互作用。

结果

与传统全科医生相比,具有自然疗法额外资质的全科医生开出植物药处方的比例更高(p<0.034;独立效应)。在非植物药处方方面未观察到这种关联。然而,在植物药和非植物药处方方面,资质与年龄组以及性别之间均存在交互作用(所有p<0.001)。资质与转诊率或住院率之间不存在进一步的独立关联,但资质与年龄组和性别之间的交互作用(仅转诊)在统计学上具有显著意义(所有p<0.0001)。

结论

结果表明,当全科医生具有自然疗法额外资质时,植物药处方的比例通常更高。传统全科医生与自然疗法全科医生在执业模式上的进一步差异可能因某些年龄组和性别而异。然而,这些差异的程度似乎相当小。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/14f9/5047621/1517ae279032/pone.0163519.g001.jpg

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