咨询频率与全科医生及行医特点。

Consultation frequency and general practitioners' and practices' characteristics.

机构信息

Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.

PW Consulting, Laxou, France.

出版信息

BMC Prim Care. 2023 Feb 4;24(1):39. doi: 10.1186/s12875-023-01996-9.

DOI:10.1186/s12875-023-01996-9

PMID:36739374

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9898930/

Abstract

BACKGROUND

High workloads generated by a few patients who consult very frequently can become huge burdens for general practitioners (GPs). Patient-related factors have been repeatedly associated with frequent consultations, but there is evidence that GPs can also influence that frequency. We investigated how patients, GPs and their practices' organisational characteristics were associated with consultation frequency.

METHODS

Data came from the SPAM Prev (Swiss Primary Health Care Active Monitoring, Prevention in primary care) national, cross-sectional survey conducted in 2015-16, including 167 GPs and 1105 patients. GPs completed an online questionnaire focused on practice organisation. Patients randomly recruited in general practices completed a questionnaire with fieldworkers. Factors predicting consultation frequency were investigated using multilevel Poisson regression models.

RESULTS

Negative associations with consultation frequency were found for females (Incidence Rate Ratio (IRR) 0.94, 95%CI [0.88-1.01]), less compliant patients (IRR 0.91, 95%CI [0.84-0.98]), high self-perceived health status (IRR 0.8, 95%CI [0.75-0.84]) and physical exercise (IRR 0.87, 95%CI [0.81-0.94]). Consultation frequencies were higher among patients with sleeping problems (IRR 1.08, 95%CI [0.96-1.23]), psychological distress (IRR 1.66, 95%CI [1.49-1.86]), chronic diseases (IRR 1.27, 95%CI [1.18-1.37]) and treatment with medication (IRR 1.24, 95%CI [1.12-1.37]). Positive associations with consultation frequency were found among GPs working longer hours (IRR 1.21, 95%CI [1.01-1.46]). Using shared medical records (IRR 0.79, 95%CI [0.67-0.92]) were negatively associated with consultation frequency.

CONCLUSION

GPs' practices' characteristics, like patients', are predictive of patients' consultation frequency, but those associations' underlying mechanisms require further qualitative investigation. These new findings could help optimise intervention strategies and reduce healthcare costs.

摘要

背景

频繁就诊的少数患者会给全科医生（GP）带来巨大的工作负担。患者相关因素与频繁就诊反复相关，但有证据表明，GP 也可以影响就诊频率。我们研究了患者、GP 及其实践的组织特征与就诊频率的关系。

方法

数据来自于 2015-2016 年进行的瑞士初级保健主动监测（初级保健预防）全国性横断面调查（SPAM Prev），包括 167 名 GP 和 1105 名患者。GP 完成了一项侧重于实践组织的在线问卷。在全科诊所中随机招募的患者由现场工作人员完成问卷。使用多水平泊松回归模型调查预测就诊频率的因素。

结果

就诊频率与女性（发病率比（IRR）0.94，95%置信区间（CI）[0.88-1.01]）、不太配合的患者（IRR 0.91，95%CI [0.84-0.98]）、自我感知健康状况较高（IRR 0.8，95%CI [0.75-0.84]）和体育锻炼（IRR 0.87，95%CI [0.81-0.94]）呈负相关。睡眠问题（IRR 1.08，95%CI [0.96-1.23]）、心理困扰（IRR 1.66，95%CI [1.49-1.86]）、慢性疾病（IRR 1.27，95%CI [1.18-1.37]）和药物治疗（IRR 1.24，95%CI [1.12-1.37]）的患者就诊频率较高。GP 工作时间较长（IRR 1.21，95%CI [1.01-1.46]）与就诊频率呈正相关。使用共享病历（IRR 0.79，95%CI [0.67-0.92]）与就诊频率呈负相关。