Bertakis K D, Robbins J A
J Fam Pract. 1987 Mar;24(3):305-9.
Five hundred twenty new patients were randomly and prospectively assigned to receive their care in the Internal Medicine Clinic or Family Practice Clinic of a large university hospital. The patients were followed by residents in training under the supervision of board-certified internists or family physicians. After a mean length of care of slightly over two years, the charts were reviewed for frequency of visits to primary care providers (internal medicine or family practice), Emergency Room, Acute Care Clinic, and all clinics other than the two primary care clinics. The records were also reviewed for laboratory tests ordered. Frequency of visits to the clinic of primary care, Emergency Room, Acute Care Clinic, and broken appointments were all significantly higher for patients randomized to the Internal Medicine Clinic. In addition, the median total annual cost of laboratory tests for patients followed by internal medicine physicians was significantly higher, largely because of higher laboratory charges generated by the specialist consultants. Over the study period, internal medicine patients had a significantly higher number of visits to all nonprimary care clinics and specifically to the dermatology, obstetrics and gynecology, and general surgery consultant clinics. It can be concluded that in this clinical environment, the practice styles of internal medicine and family practice are different.
520名新患者被随机且前瞻性地分配到一家大型大学医院的内科诊所或家庭医疗诊所接受治疗。这些患者由正在接受培训的住院医师在获得委员会认证的内科医生或家庭医生的监督下进行随访。在平均略超过两年的治疗期后，对病历进行了审查，以统计患者前往初级保健机构（内科或家庭医疗）、急诊室、急性病护理诊所以及除这两个初级保健诊所以外的所有诊所的就诊频率。还审查了所开具的实验室检查记录。随机分配到内科诊所的患者前往初级保健诊所、急诊室、急性病护理诊所的就诊频率以及失约率均显著更高。此外，由内科医生随访的患者每年实验室检查的总费用中位数显著更高，这主要是因为专科会诊医生产生的实验室费用更高。在研究期间，内科患者前往所有非初级保健诊所，特别是皮肤科、妇产科和普通外科会诊诊所的就诊次数显著更多。可以得出结论，在这种临床环境中，内科和家庭医疗的执业方式是不同的。
