Hirth R A, Fendrick A M, Chernew M E
Department of Health Management and Policy, University of Michigan, Ann Arbor 48109-2029, USA.
Med Care. 1996 Dec;34(12):1199-204. doi: 10.1097/00005650-199612000-00005.
The authors examine how specialist and generalist physicians adapted their practice patterns to emerging information on the role of Helicobacter pylori in peptic ulcer disease (PUD).
Data were collected via a mail survey sent to national random samples of gastroenterologists, family practitioners, and general internists in April 1994. A Cox proportional hazards regression was used to evaluate the determinants of the timing of adoption of antibiotic therapy for suspected or confirmed PUD.
Most respondents (99.1% of specialists and 64.6% of generalists) had prescribed antibiotic therapy to eradicate Helicobacter pylori at least once. The median specialist adopted 21 months before the medical generalist. Timing of adoption also was related to gender, board certification, PUD case load, and practice setting.
Gastroenterologists were more likely than primary care physicians to adopt antibiotic therapy for PUD, even before the evidence of this therapy's effectiveness was conclusive. Primary care physicians remained less likely to adopt after efficacy was established. The slower adoption by primary care physicians appeared to be related both to having less information than specialists about the new therapy and to more conservative practice styles. Measures to facilitate the flow of information about new technologies to primary care physicians may be warranted. Research on interspecialty differences in adoption of new therapies can contribute to understanding the consequences of the current shift from specialist- to generalist-driven care.
作者研究了专科医生和全科医生如何根据幽门螺杆菌在消化性溃疡疾病（PUD）中作用的新信息来调整他们的执业模式。
1994年4月，通过向全国随机抽取的胃肠病学家、家庭医生和普通内科医生样本发送邮件调查问卷来收集数据。采用Cox比例风险回归来评估对疑似或确诊的PUD采用抗生素治疗时间的决定因素。
大多数受访者（99.1%的专科医生和64.6%的全科医生）至少有一次开具过根除幽门螺杆菌的抗生素治疗处方。专科医生采用该治疗的时间中位数比全科医生早21个月。采用时间还与性别、委员会认证、PUD病例数量和执业环境有关。
胃肠病学家比初级保健医生更有可能对PUD采用抗生素治疗，甚至在该治疗有效性的证据确凿之前就是如此。在确立疗效后，初级保健医生采用该治疗的可能性仍然较低。初级保健医生采用较慢似乎既与比专科医生对新疗法的信息了解较少有关，也与更保守的执业风格有关。可能有必要采取措施促进新技术信息向初级保健医生的传播。对采用新疗法的专科间差异进行研究有助于理解当前从专科医生主导的医疗向全科医生主导的医疗转变的后果。
