Khan Shamima, Spotts Harlan E, Lindblad Peter C, Spooner Joshua J
College of Pharmacy and Health Sciences, Western New England University, Springfield, MA, USA.
CRE Services, Inc., New York, NY, USA.
Int J Clin Pract. 2018 May;72(5):e13092. doi: 10.1111/ijcp.13092. Epub 2018 May 6.
The patient-centred medical home (PCMH) and utilisation of a patient-centred care approach have been promoted as opportunities to improve healthcare quality while controlling expenditures.
To determine the penetration of PCMH within physician practices, and to evaluate physician attitudes towards patient-practitioner orientation. The ultimate objective was to explore relationships between the patient-practitioner orientation of respondents and the presence of PCMH elements within their practice.
A survey instrument was developed following a comprehensive literature review. Lead physicians practicing in four states were surveyed.
The adjusted response rate was 26.7%. Responses indicated increased utilisation of PCMH elements (electronic medical records, e-mail and telephone consultations, and physician performance monitoring and feedback) compared with previous research. Within a logistic regression model, medical school graduation year (1990 or later >prior to 1990), practice size (group >solo), and percentage of time allocated to patient care (less >more) were significant predictors of working in a high PCMH alignment setting. Physician and practice characteristics did not predict the level of patient-practitioner orientation, though rural physicians were more patient-centred than urban physicians. A non-linear correlation between patient-practitioner orientation and the likelihood of practicing in a low or high PCMH-aligned practice was observed.
There is a non-linear correlation between patient-practitioner orientation and the likelihood of a physician practicing in a low or high PCMH-aligned practice. The ability of a physician to work in a PCMH setting or practicing patient-centred care can go beyond a physician's aspirations to work and practice in that manner.
以患者为中心的医疗之家（PCMH）以及采用以患者为中心的护理方法已被视为在控制支出的同时提高医疗质量的契机。
确定PCMH在医师执业中的普及程度，并评估医师对医患导向的态度。最终目的是探究受访者的医患导向与其实践中PCMH要素的存在之间的关系。
在全面的文献综述之后开发了一种调查工具。对在四个州执业的主任医师进行了调查。
调整后的回复率为26.7%。回复表明，与先前的研究相比，PCMH要素（电子病历、电子邮件和电话咨询以及医师绩效监测与反馈）的使用有所增加。在逻辑回归模型中，医学院毕业年份（1990年或之后>1990年之前）、执业规模（团体执业>个体执业）以及分配给患者护理的时间百分比（较少>较多）是在高度符合PCMH模式环境中工作的重要预测因素。医师和执业特征并不能预测医患导向水平，不过农村医师比城市医师更以患者为中心。观察到医患导向与在低或高PCMH模式执业的可能性之间存在非线性相关性。
医患导向与医师在低或高PCMH模式执业的可能性之间存在非线性相关性。医师在PCMH环境中工作或以患者为中心进行护理的能力可能超出其以这种方式工作和执业的意愿。
