Owen S A, Maeyens E, Weary P E
Duke University School of Medicine, Durham, NC, USA.
J Am Acad Dermatol. 1997 Feb;36(2 Pt 1):250-6. doi: 10.1016/s0190-9622(97)70290-1.
Many factors such as cost have been used by managed care systems to limit patient access to specialty care, including dermatology. To date, however, patients' opinions regarding these decisions have not been analyzed. The purpose of the study was to survey patient opinions regarding the efficacy, costs, and desirability of gatekeeper-mediated versus direct access to dermatologic specialty care. One hundred fifteen of 150 consecutive patients who were seen in an outpatient dermatology clinic completed an anonymous survey concerning their current visit. They were asked about referral to the dermatologist by other physicians, number of prior physician visits, and efficacy of therapies received. Patients rated their level of satisfaction with generalist versus specialist care for their condition and evaluated the importance of direct access to dermatologic specialty care. Thirty-nine percent of respondents (42 of 108) were on their first visit to the dermatologist for their current condition. One half of respondents (57 of 115) had previously seen another physician for this condition. Thirty percent (34 of 115) had been referred to the dermatologist by another physician, most often a family practitioner or internist. Two thirds (38 of 57) of those seen by a previous physician had received therapy from that physician, but only one third (12 of 35) believed it to have been of any benefit. Twenty-three percent (11 of 47) claimed to have incurred more than five visits to the other physician before seeing the dermatologist. Twenty-four percent of patients (12 of 50) were "very satisfied" with the previous physician's care compared with 89% (100 of 112) with the dermatologist's care. Only 6% of respondents (7 of 122) believed a generalist could adequately treat their skin disease. Eighty-seven percent (100 of 115) described direct access to dermatology as being "very important" to their health care. The results of this study suggest that many patients may prefer dermatologic specialists over generalists as primary caregivers for diseases of the skin. They may favor direct access to dermatologic specialty care for its efficacy and for cost and time savings.
管理式医疗系统利用成本等诸多因素来限制患者获得专科护理，包括皮肤科护理。然而，迄今为止，尚未对患者对这些决策的看法进行分析。本研究的目的是调查患者对看门人介导的与直接获得皮肤科专科护理的疗效、成本和可取性的看法。在一家皮肤科门诊连续就诊的150名患者中，有115名完成了一份关于其当前就诊情况的匿名调查。他们被问及其他医生转诊至皮肤科医生的情况、之前看医生的次数以及所接受治疗的疗效。患者对全科医生与专科医生对其病情的护理满意度进行评分，并评估直接获得皮肤科专科护理的重要性。39%的受访者（108人中的42人）因当前病情首次就诊皮肤科医生。一半的受访者（115人中的57人）此前曾因该病情看过其他医生。30%（115人中的34人）是由其他医生转诊至皮肤科医生的，其中大多数是家庭医生或内科医生。之前看过其他医生的患者中有三分之二（57人中的38人）接受过该医生的治疗，但只有三分之一（35人中的12人）认为该治疗有任何益处。23%（47人中的11人）称在看皮肤科医生之前，曾去其他医生处就诊超过五次。24%的患者（50人中的12人）对之前医生的护理“非常满意”，而对皮肤科医生护理“非常满意”的比例为89%（112人中的100人）。只有6%的受访者（122人中的7人）认为全科医生能够充分治疗他们的皮肤病。87%（115人中的100人）表示直接获得皮肤科护理对他们的医疗保健“非常重要”。这项研究的结果表明，许多患者可能更倾向于皮肤科专科医生而非全科医生作为皮肤病的主要护理人员。他们可能因其疗效以及节省成本和时间而青睐直接获得皮肤科专科护理。
