Roulidis Z C, Schulman K A
Division of General Internal Medicine, Georgetown University Medical Center, Washington, DC 20007.
J Fam Pract. 1994 Nov;39(5):446-51.
One method of achieving appropriate patient treatment and continuity of care is to ensure good communication between primary care physicians and specialist physicians. We undertook an exploratory study designed to assess primary care physicians' opinions regarding communication patterns between primary care physicians and specialist physicians participating in fee-for-service and managed care health insurance plans.
A 26-question survey instrument was mailed to 110 general internists on the clinical faculty of a university hospital. Each question solicited a response for "managed care plans" and "nonmanaged care plans," with responses scored on a 5-point Likert scale ranging from 1 = never to 5 = always. Results were analyzed using the Wilcoxon signed-ranks test of the difference between responses for managed care and nonmanaged care settings.
Eighty-four physicians (76%) responded to the survey. Forty-one of these physicians participated in both managed and nonmanaged care plans and thus were eligible for the analysis. These primary care physicians reported that patients were referred more often to an unknown specialist for managed care (MC) plans than for nonmanaged care (NMC) plans (MC mean = 2.8, NMC mean = 1.4; P < .01). They also reported that when referring patients in managed care plans to a specialist, they spoke personally with specialists less often (MC mean = 2.8, NMC mean = 3.5; P < .01) and sent a written summary to specialists less often (MC mean = 2.6, NMC mean = 2.9; P < .05). Primary care physicians in this study perceived that patients in managed care plans charged primary care providers much more frequently than did those in nonmanaged care plans (MC mean = 3.8, NMC mean = 2.2; P < .01).
In this exploratory study, we found that communication between primary care and specialist physicians may be impaired when multiple health insurance plans with restricted panels of participating physicians are implemented in communities. Further research is required to confirm these findings and to assess how patient-related communication is managed.
实现恰当的患者治疗和持续护理的一种方法是确保初级保健医生和专科医生之间的良好沟通。我们开展了一项探索性研究，旨在评估初级保健医生对参与按服务收费和管理式医疗健康保险计划的初级保健医生与专科医生之间沟通模式的看法。
一份包含26个问题的调查问卷被邮寄给一所大学医院临床教员中的110名普通内科医生。每个问题都要求针对“管理式医疗计划”和“非管理式医疗计划”做出回答，回答根据从1（从不）到5（总是）的5点李克特量表进行评分。使用威尔科克森符号秩检验分析管理式医疗和非管理式医疗环境下回答之间的差异。
84名医生（76%）回复了调查。其中41名医生同时参与了管理式和非管理式医疗计划，因此有资格参与分析。这些初级保健医生报告称，与非管理式医疗（NMC）计划相比，管理式医疗（MC）计划中的患者被转诊到不认识的专科医生的情况更频繁（MC平均值 = 2.8，NMC平均值 = 1.4；P <.01）。他们还报告说，在将管理式医疗计划中的患者转诊给专科医生时，他们与专科医生亲自交谈的频率较低（MC平均值 = 2.8，NMC平均值 = 3.5；P <.01），向专科医生发送书面总结的频率也较低（MC平均值 = 2.6，NMC平均值 = 2.9；P <.05）。本研究中的初级保健医生认为，管理式医疗计划中的患者比非管理式医疗计划中的患者更频繁地向初级保健提供者收费（MC平均值 = 3.8，NMC平均值 = 2.2；P <.01）。
在这项探索性研究中，我们发现当社区中实施参与医生小组受限的多种医疗保险计划时，初级保健医生与专科医生之间的沟通可能会受到损害。需要进一步的研究来证实这些发现，并评估如何管理与患者相关的沟通。
