Biernikiewicz Małgorzata, Taieb Vanessa, Toumi Mondher
Medical Writing and Publishing Department, Creativ-Ceutical, Cracow, Poland.
HEOR Department, Evidence Synthesis Team, Creativ-Ceutical, London, UK.
J Mark Access Health Policy. 2019 Mar 27;7(1):1595953. doi: 10.1080/20016689.2019.1595953. eCollection 2019.
: Doctor-shopping has significant consequences for patients and payers and can indicate misuse of drugs, polypharmacy, less continuity of care, and increased medical expenses. This study reviewed the literature describing doctor-shoppers in the adult population. : A systematic literature review was performed in PubMed and supplemented by a Google search of grey literature. Overall, 2885 records were identified; 43 papers served as a source of definition of a doctor-shopper, disease, treatment, patient characteristics, patient special needs, country. : Definitions of doctor-shopping were heterogeneous. Overall, 40% of studies examined the use of opioids, antidepressants, or psychoactive drugs, while the others focused on chronic or frequent diseases. Most studies were conducted in countries with easy access to healthcare resources (USA, France, Taiwan, Hong Kong). The prevalence of doctor-shopping ranged from 0.5% among opioid users in the USA to 25% of patients registered at general practices in Japan. Comorbidities, active substance abuse, greater distance from healthcare facility, younger age, longer disease and poor patient satisfaction increased doctor-shopping. : Knowing the characteristics of doctor-shoppers may help identify such patients and reduce the associated waste of medical resources, but concerns about the misuse of drugs or healthcare resources should not prevent proper disease management.
频繁更换医生就诊对患者和医保支付方都会产生重大影响,还可能暗示药物滥用、多种药物并用、医疗照护连续性欠佳以及医疗费用增加。本研究回顾了描述成年人群中频繁更换医生就诊者的文献。
在PubMed数据库中进行了系统的文献综述,并通过谷歌搜索补充灰色文献。总共识别出2885条记录;43篇论文作为频繁更换医生就诊者、疾病、治疗、患者特征、患者特殊需求、国家等方面定义的来源。
频繁更换医生就诊的定义各不相同。总体而言,40%的研究考察了阿片类药物、抗抑郁药或精神活性药物的使用情况,而其他研究则聚焦于慢性或常见疾病。大多数研究在医疗资源获取便利的国家(美国、法国、台湾地区、香港地区)开展。频繁更换医生就诊的患病率从美国阿片类药物使用者中的0.5%到日本普通诊所登记患者中的25%不等。合并症、药物滥用、距离医疗机构较远、年龄较小、病程较长以及患者满意度较低会增加频繁更换医生就诊的情况。
了解频繁更换医生就诊者的特征可能有助于识别这类患者,并减少相关的医疗资源浪费,但对药物或医疗资源滥用的担忧不应妨碍对疾病进行恰当管理。