Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, 4028 Debrecen, Hungary.
Department of Financing, National Institute of Health Insurance Fund Management, 1139 Budapest, Hungary.
Int J Environ Res Public Health. 2019 Aug 29;16(17):3153. doi: 10.3390/ijerph16173153.
The performance of general practitioners (GPs) is frequently assessed without considering the factors causing variability among general medical practices (GMPs). Our cross-sectional national-based study was performed in Hungary to evaluate the influence of GMP characteristics on performance indicators. The relationship between patient's characteristics (age, gender, education) and GMP-specific parameters (practice size, vacancy of GP's position, settlement type, and county of GMP) and the quality of care was assessed by multilevel logistic regression models. The variations attributable to physicians were small (from 0.77% to 17.95%). The education of patients was associated with 10 performance indicators. Practicing in an urban settlement mostly increased the quality of care for hypertension and diabetes care related performance indicators, while the county was identified as one of the major determinants of variability among GPs' performance. Only a few indicators were affected by the vacancy and practice size. Thus, the observed variability in performance between GPs partially arose from demographic characteristics and education of patients, settlement type, and regional location of GMPs. Considering the real effect of these factors in evaluation would reflect better the personal performance of GPs.
本研究在匈牙利全国范围内开展了一项横断面研究，旨在评估一般医疗实践（GMP）特征对绩效指标的影响。我们采用多水平逻辑回归模型评估了患者特征（年龄、性别、教育）和 GMP 特定参数（实践规模、GP 职位空缺、定居类型和 GMP 县）与医疗质量之间的关系。医生造成的变异很小（从 0.77%到 17.95%）。患者的教育与 10 项绩效指标有关。在城市定居点行医大多提高了高血压和糖尿病护理相关绩效指标的医疗质量，而县被确定为 GP 绩效差异的主要决定因素之一。只有少数指标受到职位空缺和实践规模的影响。因此，GP 之间绩效的观察到的变异性部分源于患者的人口统计学特征和教育、定居类型以及 GMP 的区域位置。在评估中考虑这些因素的实际影响将更好地反映 GP 的个人绩效。
