美国医生和医学生对成本意识医疗的态度：按年龄和培训阶段分析的全国横断面调查数据。
Attitudes toward cost-conscious care among U.S. physicians and medical students: analysis of national cross-sectional survey data by age and stage of training.
机构信息
Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Medical education and medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
出版信息
BMC Med Educ. 2018 Nov 22;18(1):275. doi: 10.1186/s12909-018-1388-7.
BACKGROUND
The success of initiatives intended to increase the value of health care depends, in part, on the degree to which cost-conscious care is endorsed by current and future physicians. This study aimed to first analyze attitudes of U.S. physicians by age and then compare the attitudes of physicians and medical students.
METHODS
A paper survey was mailed in mid-2012 to 3897 practicing physicians randomly selected from the American Medical Association Masterfile. An electronic survey was sent in early 2015 to all 5,992 students at 10 U.S. medical schools. Survey items measured attitudes toward cost-conscious care and perceived responsibility for reducing healthcare costs. Physician responses were first compared across age groups (30-40 years, 41-50 years, 51-60 years, and > 60 years) and then compared to student responses using Chi square tests and logistic regression analyses (controlling for sex).
RESULTS
A total of 2,556 physicians (65%) and 3395 students (57%) responded. Physician attitudes generally did not differ by age, but differed significantly from those of students. Specifically, students were more likely than physicians to agree that cost to society should be important in treatment decisions (p < 0.001) and that physicians should sometimes deny beneficial but costly services (p < 0.001). Students were less likely to agree that it is unfair to ask physicians to be cost-conscious while prioritizing patient welfare (p < 0.001). Compared to physicians, students assigned more responsibility for reducing healthcare costs to hospitals and health systems (p < 0.001) and less responsibility to lawyers (p < 0.001) and patients (p < 0.001). Nearly all significant differences persisted after controlling for sex and when only the youngest physicians were compared to students.
CONCLUSIONS
Physician attitudes toward cost-conscious care are similar across age groups. However, physician attitudes differ significantly from medical students, even among the youngest physicians most proximate to students in age. Medical student responses suggest they are more accepting of cost-conscious care than physicians and attribute more responsibility for reducing costs to organizations and systems rather than individuals. This may be due to the combined effects of generational differences, new medical school curricula, students' relative inexperience providing cost-conscious care within complex healthcare systems, and the rapidly evolving U.S. healthcare system.
背景
旨在提高医疗保健价值的举措的成功，部分取决于当前和未来医生对成本意识护理的认可程度。本研究旨在首先通过年龄分析美国医生的态度，然后比较医生和医学生的态度。
方法
2012 年中期，向美国医学协会大师档案中随机抽取的 3897 名执业医师邮寄纸质调查问卷。2015 年初，向 10 所美国医学院的所有 5992 名学生发送电子调查问卷。调查项目衡量了对成本意识护理的态度以及对降低医疗保健成本的感知责任。首先比较不同年龄组（30-40 岁、41-50 岁、51-60 岁和>60 岁）的医生的反应，然后使用卡方检验和逻辑回归分析（控制性别）与学生的反应进行比较。
结果
共有 2556 名医生（65%）和 3395 名学生（57%）做出了回应。医生的态度总体上不因年龄而异，但与学生的态度有显著差异。具体来说，与医生相比，学生更有可能同意社会成本应在治疗决策中重要（p<0.001），并且医生有时应拒绝有益但昂贵的服务（p<0.001）。学生认为在优先考虑患者福利的同时要求医生注意成本是不公平的（p<0.001）的可能性较小。与医生相比，学生认为医院和医疗系统在降低医疗成本方面承担更多的责任（p<0.001），而律师（p<0.001）和患者（p<0.001）承担的责任较少。在控制性别和仅将最年轻的医生与学生进行比较后，几乎所有显著差异仍然存在。
结论
医生对成本意识护理的态度在年龄组之间相似。然而，医生的态度与医学生有很大的不同，即使是在年龄上最接近学生的最年轻医生也是如此。医学生的反应表明，他们比医生更容易接受成本意识护理，并将更多的责任归因于组织和系统降低成本，而不是个人。这可能是由于代际差异、新的医学院课程、学生在复杂的医疗保健系统中提供成本意识护理的相对经验不足以及美国医疗保健系统的快速发展所致。
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