Knight John C, Mathews Maria, Aubrey-Bassler Kris
Affiliations: Primary Healthcare Research Unit (Knight, Aubrey-Bassler), Faculty of Medicine, Memorial University; Newfoundland and Labrador Centre for Health Information (Knight); Division of Community Health and Humanities (Knight, Mathews) and Discipline of Family Medicine (Aubrey-Bassler), Faculty of Medicine, Memorial University, St. John's, Nfld.
CMAJ Open. 2017 Oct 6;5(4):E746-E752. doi: 10.9778/cmajo.20170007.
Physician turnover, involving physicians' leaving clinical practice in a specific area, may disrupt continuity of care, leading to poorer health outcomes and greater use of health care services. The purpose of this study was to investigate the relation between family physician retention and avoidable hospital admission for ambulatory-care-sensitive conditions.
We conducted a population-based cross-sectional study using provincial health administrative data for residents of Newfoundland and Labrador who held a provincial health card between 2001 and 2009. Five-year family physician retention was calculated by regional economic zone, and residents within economic zones were grouped into tertiles based on physician retention level. We compared hospital admission for ambulatory-care-sensitive conditions among tertiles while adjusting for covariates.
For 475 691 residents of the province, there was a negative relation between physician retention and hospital admission for ambulatory-care-sensitive conditions: residents of areas with moderate or low physician retention had admission rates that were 16.5% (95% confidence interval [CI) 12.6%-20.4%) and 19.9% (95% CI 15.2%-24.7%) higher, respectively, compared to areas with high retention. No relation was found when analysis was limited to those aged 65 years or more.
The findings suggest that high physician retention is associated with lower rates of hospital admission for ambulatory-care-sensitive conditions even after control for other factors. This is consistent with our hypothesis that physician turnover acts to disrupt continuity of care, resulting in higher admission rates.
医生流失，即医生离开特定领域的临床实践，可能会扰乱医疗服务的连续性，导致健康状况更差以及医疗服务使用增加。本研究的目的是调查家庭医生留存率与非卧床护理敏感型疾病可避免住院之间的关系。
我们利用2001年至2009年期间持有省级健康卡的纽芬兰和拉布拉多省居民的省级卫生行政数据进行了一项基于人群的横断面研究。按区域经济区计算五年家庭医生留存率，并根据医生留存水平将经济区内的居民分为三分位数。我们在调整协变量的同时比较了三分位数之间非卧床护理敏感型疾病的住院情况。
对于该省的475691名居民，医生留存率与非卧床护理敏感型疾病的住院之间存在负相关关系：与留存率高的地区相比，留存率中等或低的地区居民的住院率分别高出16.5%（95%置信区间[CI]12.6%-20.4%）和19.9%（95%CI 15.2%-24.7%）。当分析仅限于65岁及以上人群时，未发现相关性。
研究结果表明，即使在控制了其他因素之后，高医生留存率与非卧床护理敏感型疾病的较低住院率相关。这与我们的假设一致，即医生流失会扰乱医疗服务的连续性，导致更高的住院率。
