Isherwood J, Malcolm L A, Hornblow A R
N Z Med J. 1982 Jan 13;95(699):14-7.
In this exploratory study information gathered from 520 patients of eight doctors in a city group practice was analysed to identify the collective and separate contributions of selected patient and doctor factors to script cost variations. Results suggested that variance in cost and item numbers was directly related to diagnosis. A principal diagnosis of hypertension or diabetes/endocrine/hormonal problems, or a multiple of diagnoses was associated most with high cost scripts. Other patient conditions, such as gravity of illness, accounted for a much smaller but still significant variance. Although there were only minor differences between males and females, the older age groups in both sexes were over-represented in the higher item and cost categories. Which doctor the patient saw accounted only for approximately half a percent of the total variance, and this was non-significant. The results indicated that doctor prescribing behaviour was related rationally to patient diagnosis, and suggested that peer review, as practised by these doctors, was operating to reduce both variance between doctor factors and prescribing costs.
在这项探索性研究中，对来自一个城市团体诊所中8位医生的520名患者收集的信息进行了分析，以确定选定的患者和医生因素对处方成本差异的集体和单独影响。结果表明，成本和项目数量的差异与诊断直接相关。高血压或糖尿病/内分泌/激素问题的主要诊断，或多种诊断，与高成本处方的关联最大。其他患者状况，如疾病严重程度，占比小得多，但仍有显著差异。虽然男性和女性之间只有微小差异，但两个性别的老年群体在高项目和高成本类别中占比过高。患者看哪位医生仅占总差异的约0.5%，且不显著。结果表明，医生的处方行为与患者诊断合理相关，并表明这些医生所实行的同行评审正在发挥作用，以减少医生因素之间的差异和处方成本。
