Fournier P O, Baldor R A, Warfield M E, Frazier B
Department of Family & Community Medicine, University of Massachusetts Medical Center, Worcester 01655, USA.
J Fam Pract. 1997 Jan;44(1):85-9.
This study investigated Massachusetts family physicians' current care and referral practices with respect to HIV/AIDS patients and examined actors that might influence family physicians in referring these patients to specialists. Educational opportunities for physicians with regard to HIV were also examined.
In 1994, a 2-page survey was mailed to the 468 members of the Massachusetts Academy of Family Physicians. The survey questionnaire examined such factors as whether the respondents were teaching or nonteaching, rural or urban; number of years since medical school or residency training; and knowledge and attitudes with regard to HIV/AIDS patients. The data were analyzed using Student's t test, chi-square, and correlation analysis.
Usable responses were returned by 281 (60%) of the physicians surveyed. Of these, 65% reported having HIV patients in their practice, and 46% reported having AIDS patients was being managed alone by 53% of these physicians, and 11% managed their patients with AIDS. Physicians providing care for HIV/AIDS patients were more likely to be practicing in urban locations, have three or more HIV/AIDS patients in their practice, or recently graduated from residency. Additionally, they were more likely to be involved in residency teaching programs. Those who did not care for HIV/AIDS patients felt less knowledgeable about HIV/AIDS care, and felt that they had no time in their practice to care for this population of patients. Physicians with HIV patients learn more about HIV care from their colleagues than those without HIV patients.
Family physicians are increasingly seeing HIV/AIDS patients in their offices. The majority are continually caring for these patients, either by themselves or co-managing their care with a specialist. Local CME programs relying on colleagues and community resources to discuss management of these patients may be one of the best ways of ensuring that increasing numbers of family physicians obtain the appropriate knowledge to care for these patients within their own communities.
本研究调查了马萨诸塞州家庭医生对艾滋病毒/艾滋病患者的当前护理和转诊做法，并研究了可能影响家庭医生将这些患者转诊给专科医生的因素。同时还考察了医生关于艾滋病毒的教育机会。
1994年，向马萨诸塞州家庭医生学会的468名成员邮寄了一份两页的调查问卷。调查问卷考察了诸如受访者是从事教学还是非教学工作、在农村还是城市工作；自医学院或住院医师培训结束后的年数；以及对艾滋病毒/艾滋病患者的知识和态度等因素。数据采用学生t检验、卡方检验和相关分析进行分析。
281名（60%）接受调查的医生返回了有效回复。其中，65%报告在其诊疗工作中有艾滋病毒患者，46%报告有艾滋病患者。这些医生中有53%独自管理艾滋病患者，11%与他人共同管理其艾滋病患者。为艾滋病毒/艾滋病患者提供护理的医生更有可能在城市地区执业，其诊疗工作中有三名或更多艾滋病毒/艾滋病患者，或者最近刚从住院医师培训毕业。此外，他们更有可能参与住院医师教学项目。那些不护理艾滋病毒/艾滋病患者的医生觉得自己对艾滋病毒/艾滋病护理了解较少，并且觉得自己在诊疗工作中没有时间护理这类患者。有艾滋病毒患者的医生比没有艾滋病毒患者的医生从同事那里学到更多关于艾滋病毒护理的知识。
家庭医生在其诊所中越来越多地诊治艾滋病毒/艾滋病患者。大多数医生持续护理这些患者，要么独自护理，要么与专科医生共同管理其护理。依靠同事和社区资源来讨论这些患者管理问题的当地继续医学教育项目可能是确保越来越多的家庭医生在其所在社区获得护理这些患者所需适当知识的最佳方式之一。
