McAvoy B, Davis P, Raymont A, Gribben B
Department of General Practice, University of Auckland School of Medicine.
N Z Med J. 1994 Sep 28;107(986 Pt 2):388-433.
Objective. The main objective of this study is to provide a comprehensive description of general practice in the Waikato, an area which represents many aspects of New Zealand. Accurate, detailed and up to date information in this area is needed for future planning of medical education and the provision of health services. Survey method. The survey was conducted over one year, from September 1991 to August 1992. Participating general practitioners and practice nurses recorded details of a sample of patient encounters in the surgery or on home visits. Each participant was assigned four single weeks for data gathering over the course of the year. A one in five sub-sample of patients was also given questionnaires to complete immediately and two weeks after the consultations. This component of the study was reported elsewhere. Participants. A list of all active general practitioners working within the area covered by the Waikato Area Health board was constructed. All were contacted during May and June 1991 and asked to contribute to the study. During this initial, recruiting stage the practitioners and their practice nurses were asked to provide details of their professional background and to outline the structure, functions and size of their practices. Data collection. The variables studied included: provider characteristics (age, gender, qualifications, type of practice and services offered); patient attributes (age, gender, ethnicity, benefit category and occupation); patient reasons for encounter (up to four per encounter); doctor diagnoses (again up to four per encounter); drugs prescribed and or other treatments provided; tests and investigations ordered and referrals made; planned follow up and subjective view on the encounter. Data were centrally coded by trained staff. Patient reasons for encounter were coded according to NAMCS, practitioner diagnoses were classified into OXMIS, and drugs prescribed were allocated into the ATC classification system. Participation rate. 87% of practitioners (182/209), 89% of practices (95/107), and 80% of practice nurses (150/189) completed the initial recruitment survey. The participation rate at the first phase of the encounter survey was 80.5% (169/210), but this had dropped to 65.7% (136/207) by the fourth collection week. An overall response rate of 68.6% was achieved, representing successful collection of encounter data in 562 of 819 potential doctor recording weeks. On average, general practitioners recorded 109 encounters per week, from which they selected on average a sample of 23 patients for the survey. They described 141 problems per 100 encounters, of which 49 were new. On average general practitioners made less than three home visits per 100 encounters.(ABSTRACT TRUNCATED AT 400 WORDS)
目的。本研究的主要目的是全面描述怀卡托地区的全科医疗情况，该地区代表了新西兰的许多方面。医疗教育未来规划和医疗服务提供需要该领域准确、详细且最新的信息。
调查方法。调查为期一年，从1991年9月至1992年8月。参与的全科医生和执业护士记录了在诊所或家访中患者诊疗情况样本的详细信息。每位参与者在这一年中被分配四个单周用于数据收集。还抽取了五分之一的患者样本，让他们在诊疗后立即以及两周后填写问卷。该研究的这一部分已在其他地方报道。
参与者。编制了一份在怀卡托地区卫生委员会覆盖区域内所有在职全科医生的名单。1991年5月和6月期间联系了所有人，并邀请他们参与研究。在这个初始招募阶段，要求医生及其执业护士提供他们的专业背景细节，并概述其诊所的结构、功能和规模。
数据收集。研究的变量包括：提供者特征（年龄、性别、资质、诊所类型和提供的服务）；患者属性（年龄、性别、种族、福利类别和职业）；患者就诊原因（每次就诊最多四个）；医生诊断（每次就诊同样最多四个）；所开药物和/或提供的其他治疗；所安排的检查和转诊；计划的随访以及对此次诊疗的主观看法。数据由经过培训的工作人员进行集中编码。患者就诊原因根据美国国家门诊医疗调查（NAMCS）进行编码，医生诊断归类到牛津医学信息系统（OXMIS），所开药物分配到解剖学治疗学及化学分类系统（ATC）。
参与率。87%的医生（182/209）、89%的诊所（95/107）和80%的执业护士（150/189）完成了初始招募调查。诊疗调查第一阶段的参与率为80.5%（169/210），但到第四个收集周时已降至65.7%（136/207）。总体回复率为68.6%，即在819个潜在医生记录周中有562个成功收集到了诊疗数据。平均而言，全科医生每周记录109次诊疗，他们平均从中选取23名患者作为调查样本。他们每100次诊疗描述141个问题，其中49个是新问题。平均而言，全科医生每100次诊疗进行不到三次家访。（摘要截选至400字）
