Montalto M, Adams G, Dunt D R, Street A
Department of Public Health and Community Medicine, University of Melbourne, Fairfield Hospital, Victoria.
Med J Aust. 1995 Aug 21;163(4):187-90. doi: 10.5694/j.1326-5377.1995.tb124520.x.
To investigate differences in the characteristics of general practitioners (GPs) and patients, referral rates, rates of prescribing and ordering of tests and x-rays, and types of counselling and consultation, between private and community health centre (CHC) GPs in Victoria.
All 51 full-time Victorian CHC GPs were invited to enrol in the Australian Morbidity and Treatment Survey (AMTS) developed by the Family Medicine Research Unit at the University of Sydney in 1992. The control group comprised the 114 Victorian GPs involved in this survey in 1991.
Thirty-nine CHC GPs (76%) provided complete data. CHC GPs were more likely to be younger, female, and to have less experience in general practice. Patient age and gender distributions were similar. CHC GPs had higher rates of offering counselling and advice and of referral to allied health professionals, but similar rates of referral to medical specialists to those of private GPs. We found no differences in prescribing after multivariate analysis.
Counselling, and referral to allied health professionals, were the only striking differences after multivariate analysis. It may be that any movement toward non-throughput-related remuneration may, in isolation, have less impact on general practitioner work patterns than imagined. Patient throughput was not measured, and this would be important in any future global assessment of the cost-effectiveness of CHC and private general practitioners.
调查维多利亚州私立全科医生与社区卫生中心（CHC）全科医生在医生和患者特征、转诊率、检查及X光检查的开具率以及咨询和会诊类型方面的差异。
邀请维多利亚州所有51名全职CHC全科医生参与由悉尼大学家庭医学研究单位于1992年开展的澳大利亚发病率和治疗调查（AMTS）。对照组包括1991年参与该调查的114名维多利亚州全科医生。
39名CHC全科医生（76%）提供了完整数据。CHC全科医生更可能较年轻、为女性，且在全科医疗方面经验较少。患者的年龄和性别分布相似。CHC全科医生提供咨询和建议以及转诊至专职医疗人员的比例较高，但转诊至医学专科医生的比例与私立全科医生相似。多变量分析后我们未发现开药方面的差异。
多变量分析后，咨询以及转诊至专职医疗人员是唯一显著的差异。单独来看，任何朝着与诊疗量无关的薪酬模式的转变，对全科医生工作模式的影响可能比想象的要小。未对患者诊疗量进行测量，而这在未来对CHC和私立全科医生成本效益的任何全面评估中都将是重要的。
