Dowell J S, Snadden D, Dunbar J A
Tayside Centre for General Practice, University of Dundee, Scotland.
Soc Sci Med. 1996 Dec;43(11):1543-9. doi: 10.1016/s0277-9536(96)00050-0.
The cost of prescribed medication is an increasing burden on health care systems. British general practitioners have been encouraged to reduce their prescribing costs through financial incentives within the fundholding scheme. This study reports on one general practice which reduced prescribing expenditure as part of the move to fundholding. Interviews performed with practice staff and patients were analysed and combined with prescribing statistics and questionnaire data to give a picture of the balance between the experience of patients and practitioners. Fifty-three interviews with 17 patients revealed that most were willing to try cheaper treatments and that dissatisfaction was primarily with the communication they received rather than the change itself. Each patient had to decide how to respond to the change in their medication. The decision-making process and the main factors involved are described and discussed. The experience of having long-standing treatment changed can have an impact on the doctor-patient relationship. This was not found to be a large problem and, it is suggested, can be guarded against. Large-scale economies in prescribing are feasible for some practices, and patients will tolerate such changes if attention is paid to sensitive communication.
处方药费用给医疗保健系统带来的负担日益加重。英国的全科医生受到鼓励，通过基金持有计划中的经济激励措施来降低其开药成本。本研究报告了一家全科诊所，该诊所作为向基金持有转变的一部分，降低了开药支出。对诊所工作人员和患者进行的访谈进行了分析，并与开药统计数据和问卷调查数据相结合，以描绘患者和从业者体验之间的平衡情况。对17名患者进行的53次访谈显示，大多数患者愿意尝试更便宜的治疗方法，他们的不满主要在于所得到的沟通，而非改变本身。每位患者都必须决定如何应对其用药的变化。文中描述并讨论了决策过程及所涉及的主要因素。长期治疗发生改变的经历可能会对医患关系产生影响。但研究发现这并非大问题，并且建议可以加以防范。对于一些诊所来说，大规模的开药节约是可行的，如果注重敏感沟通，患者会容忍此类变化。
