Rosen M A, Logsdon D N, Demak M M
Prev Med. 1984 Sep;13(5):535-48. doi: 10.1016/0091-7435(84)90022-7.
The INSURE Project on Lifecycle Preventive Health Services is a 3-year feasibility study to develop and test a clinical model of preventive health services, including patient education, in primary medical care as an insurance benefit. Seventy-four primary care physicians in group practices were surveyed regarding their baseline attitudes toward, and practice of, preventive services. Physicians report that they tend to be conscientious in educating their patients about their health risks, although they spend little time in patient education. Physicians are not sanguine about their success in getting their patients to follow their recommendations and tend to harbor doubts about their own efficacy in these areas. Specialty differences exist in these parameters. Physicians evidence contradictory attitudes about prevention. They believe doctors should spend more time providing preventive services but also believe that the lack of insurance reimbursement is an obstacle to providing these services. The concept of structural or sociological ambivalence is advanced to explain this pattern.
“生命周期预防性健康服务保险项目”（INSURE项目）是一项为期3年的可行性研究，旨在开发并测试一种预防性健康服务的临床模式，该模式包括在初级医疗保健中作为保险福利的患者教育。对74名参与团体医疗服务的初级保健医生进行了调查，了解他们对预防性服务的基线态度和实践情况。医生报告称，他们在向患者宣传健康风险方面往往尽职尽责，尽管他们在患者教育上花费的时间很少。医生们对让患者遵循他们的建议并不乐观，并且往往对自己在这些方面的成效心存疑虑。在这些参数方面存在专业差异。医生们对预防表现出矛盾的态度。他们认为医生应该花更多时间提供预防性服务，但也认为缺乏保险报销是提供这些服务的障碍。文中提出了结构或社会学矛盾心理的概念来解释这种模式。
