按执业环境和研究生水平比较连续性门诊经历

Rice T D, Holmes S E, Drutz J E

Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.

Arch Pediatr Adolesc Med. 1996 Dec;150(12):1299-304. doi: 10.1001/archpedi.1996.02170370077013.

OBJECTIVE

To compare continuity clinic experiences by practice setting and postgraduate level.

DESIGN

Mailed questionnaire.

SETTING

Baylor College of Medicine pediatric residents selected 1 of 3 continuity practice settings, including community-based private offices (n = 35) and university-based clinics in a private (n = 71) and a public (n = 12) hospital.

SUBJECTS

One hundred eighteen pediatric residents, May 1993.

OUTCOME MEASURES

Patient volume, continuity of care, type of patient visit, and faculty supervision.

RESULTS

The response rate was 77% (91/118). Pediatric residents in community-based private offices reported seeing more patients per session than those in the university-based private and public clinics (88%, 10%, and 0% residents in the respective practice settings reported > or = 4 patients per session), but were less likely to see patients repeatedly (6%, 68%, and 40% residents in the respective practice settings had seen more than half their patients > 2 times). Residents in private offices provided a smaller percentage of well child care (16%, 61%, and 90% residents in the respective practice settings reported > 50% patients were well) and more acute care (68%, 15% and 0% residents in the respective practice settings reported > 25% patients were acutely ill). Residents in private offices reported a higher percentage of time spent observing only (33%, 0%, and 0% residents in the respective practice settings observed > 25% of the time) and less time managing patients independently (93%, 59%, and 40% residents, respectively, managed < or = 25% of the time). No significant differences among postgraduate levels were found for these variables.

CONCLUSIONS

Patient volume, continuity of care, type of patient visit, and faculty supervision were significantly different among continuity practice settings. Postgraduate level of training did not affect significantly these measures of continuity clinic experience. These differences need to be considered in curriculum development.

目的

比较不同执业环境和研究生水平下的连续性诊所经历。

设计

邮寄问卷调查。

地点

贝勒医学院的儿科住院医师从3种连续性执业环境中选择1种，包括社区私人诊所（n = 35）以及私立（n = 71）和公立（n = 12）医院的大学附属医院。

研究对象

1993年5月的118名儿科住院医师。

观察指标

患者数量、医疗连续性、患者就诊类型和教员监督。

结果

回复率为77%（91/118）。社区私人诊所的儿科住院医师报告称，每次门诊看诊的患者比私立和公立大学附属医院的住院医师更多（各自执业环境中分别有88%、10%和0%的住院医师报告每次门诊看诊≥4名患者），但重复看诊患者的可能性较小（各自执业环境中分别有6%、68%和40%的住院医师看过半数患者超过2次）。私人诊所的住院医师提供的健康儿童保健比例较小（各自执业环境中分别有16%、61%和90%的住院医师报告＞50%的患者健康），而急性病护理较多（各自执业环境中分别有68%、15%和0%的住院医师报告＞25%的患者患有急性病）。私人诊所的住院医师报告仅观察的时间占比更高（各自执业环境中分别有33%、0%和0%的住院医师观察时间＞25%），而独立管理患者的时间较少（分别有93%、59%和40%的住院医师管理时间≤25%）。这些变量在研究生水平之间未发现显著差异。