Detollenaere Jens, Boeckxstaens Pauline, Willems Sara
Affiliation: Faculty of Medicine and Health Sciences, Department of Family Medicine and Primary Health Care, Ghent University, Gent, Belgium.
CMAJ Open. 2018 Apr 18;6(2):E176-E183. doi: 10.9778/cmajo.20170082.
Previous research has shown that person-centred care has beneficial effects on several health-related outcomes. We investigated the association between a general practitioner's person-centred attitude and financially driven postponement of care in European countries.
In this cross-sectional study, data were collected within the Quality and Costs of Primary Care in Europe study, which included 69 201 patients and 7183 general practitioners from 31 European countries (all 27 European Union member states, 2 candidate states [former Yugoslav Republic of Macedonia and Turkey], Norway and Switzerland). Financially driven postponement of care was measured by asking patients whether they had postponed care for financial reasons in the previous 12 months. We constructed a variable for person-centredness using a previously published conceptual framework: 1) exploring both the disease and the illness experience, 2) understanding the whole person, 3) finding common ground and 4) enhancing the patient-physician relationship. We analyzed the data using multilevel logistic regression modelling, adjusting for the strength of a country's primary care system.
Having a low income was associated with higher financially driven postponement of care. General practitioners with a person-centred attitude were associated with lower rates of financially driven postponement among their patients. An increase in general practitioners' person-centredness with 1 standard deviation was associated with a decreased likelihood of postponement of care for financial reasons (odds ratio 0.923, 95% confidence interval 0.869-0.981).
Person-centred care by general practitioners in Europe was associated with lower financially driven postponement of care, irrespective of the strength of a country's primary care system.
先前的研究表明，以患者为中心的护理对若干与健康相关的结果具有有益影响。我们调查了欧洲国家全科医生以患者为中心的态度与因经济因素导致的护理延迟之间的关联。
在这项横断面研究中，数据收集于欧洲初级保健质量与成本研究，该研究纳入了来自31个欧洲国家（所有27个欧盟成员国、2个候选国[前南斯拉夫的马其顿共和国和土耳其]、挪威和瑞士）的69201名患者和7183名全科医生。通过询问患者在过去12个月内是否因经济原因推迟护理来衡量因经济因素导致的护理延迟。我们使用先前发表的概念框架构建了一个以患者为中心的变量：1）探究疾病和患病体验，2）了解患者整体，3）找到共同点，4）加强医患关系。我们使用多水平逻辑回归模型分析数据，并对一个国家初级保健系统的强度进行了调整。
低收入与因经济因素导致的护理延迟率较高相关。具有以患者为中心态度的全科医生，其患者因经济因素导致的护理延迟率较低。全科医生的以患者为中心程度增加1个标准差，与因经济原因推迟护理的可能性降低相关（优势比0.923，95%置信区间0.869 - 0.981）。
欧洲全科医生提供的以患者为中心的护理与因经济因素导致的护理延迟率较低相关，与一个国家初级保健系统的强度无关。
