Zaytseva Anna, Verger Pierre, Ventelou Bruno
SBS-EM, DULBEA, Université libre de Bruxelles, Brussels, Belgium.
ORS PACA, Southeastern Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France.
Health Serv Insights. 2025 May 6;18:11786329251331128. doi: 10.1177/11786329251331128. eCollection 2025.
Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.
To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).
We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.
In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.
Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.
I14, I18.
综合初级保健团队在家庭医学中仍是一个有争议的政策，这可能是对法国医疗密度不足的一种便捷应对措施。
分析全科医生（GP）如何根据护理的数量和质量，应对其执业区域内全科医生供应不足的情况，以及这种应对如何通过加入综合初级保健团队——多专业团体执业（MGP）来调节。
我们对1209名法国全科医生的3项代表性横断面调查（2019 - 2020年）进行了结构方程建模。护理的数量和质量由潜在变量近似表示，分别包括全科医生的需求吸收能力和疫苗推荐频率。
在没有潜在调节因素的情况下，低全科医生密度与护理数量呈负相关（-0.221，非标准化直接效应），但与护理质量无关。在有调节因素的情况下，低全科医生密度与更高的工作相关压力相关（0.120），这继而与需求吸收能力下降相关（-0.202）。更多地使用电子健康工具与更多参与疫苗推荐相关（0.357）。在多专业团体执业中的全科医生比在团体执业之外执业的全科医生倾向于更多地使用电子健康工具（0.032），对疫苗推荐有积极影响。
较低水平的工作相关压力是处理患者请求的关键调节因素。在纠正加入多专业团体执业的自我选择偏差后，我们发现加入多专业团体执业对护理数量没有显著的调节作用，但对护理质量有影响。我们的结果指出了加入多专业团体执业对护理质量的附加价值，倡导其进一步发展。
JEL分类：I14，I18。
