Dietrich A J, Goldberg H
Am J Public Health. 1984 Mar;74(3):223-7. doi: 10.2105/ajph.74.3.223.
We compared preventive care performed by 20 generalists and 20 subspecialists practicing in Santa Clara and San Mateo Counties, California, by auditing charts of adult primary care patients for compliance with recommendations of the Canadian Task Force on the Periodic Health Examination. Generalists and subspecialists both provided 49 per cent of recommended preventive services. The two groups did not differ significantly in performance of any individual service. Performance varied widely within both groups. Of many factors explored, only two were associated with more preventive services: provision of a complete physical examination to the patient, and a physician's belief in the importance of a given service. The "generalist vs. subspecialist" debate assumes that a physician's specialty classification is an important predictor of behavior. For the performance of preventive care, this was not true in our study. Instead, physicians' beliefs and practice habits may be major determinants of the quality of preventive care provided. These exploratory findings needed confirmation in other settings.
我们通过审核加利福尼亚州圣克拉拉县和圣马特奥县20名全科医生和20名专科医生为成年初级保健患者提供预防性保健服务的图表，以评估其是否符合加拿大定期健康检查特别工作组的建议，进而对二者进行了比较。全科医生和专科医生提供的预防性保健服务均达到了建议标准的49%。两组在任何一项具体服务的执行情况上均无显著差异。两组内部的表现差异都很大。在研究的诸多因素中，只有两项与更多的预防性服务相关：为患者进行全面体检，以及医生对特定服务重要性的信念。“全科医生与专科医生”之争假定医生的专业分类是行为的重要预测指标。在我们的研究中，就预防性保健服务的执行情况而言，并非如此。相反，医生的信念和执业习惯可能是所提供预防性保健服务质量的主要决定因素。这些探索性研究结果需要在其他环境中得到证实。
