Franks P, Clancy C M, Nutting P A
Primary Care Institute, Highland Hospital, Rochester, NY 14620, USA.
Med Care. 1997 Jul;35(7):655-68. doi: 10.1097/00005650-199707000-00001.
Efforts to contain health care costs have increased interest in defining which specialties provide primary care and in developing tools to assess the delivery of primary care services.
Using data from the 1985-1991 National Ambulatory Medical Care Surveys, the authors examined the activities of 29 physician specialty groups to determine whether the recent Institute of Medicine definition of primary care could be operationalized. Ten elements were identified that addressed comprehensiveness (first-contact care, a Herfindahl Index, previous contact for other problems, prevention, and care through the life cycle), coordination (referrals), continuity (any previous contact), and accessibility (care provided to black patients, those on Medicaid, and patients in rural areas).
Principal component and factor analyses suggested that each element, except care through the life cycle, contributed to the construct of primary care. Principal component analysis enabled ordering of specialties according to their "primary careness," suggesting that specialties other than family/general practice, pediatrics, and internal medicine make significant contributions to primary care. Factor analysis suggested that two factors related to process and content underlie the definition of primary care and emphasize the importance of integration of services provided. This analysis provides a basis for further empirical work to develop measures of primary care performance.
National surveys need to be modified to provide a more comprehensive assessment of primary care in the United States.
控制医疗保健成本的努力使得人们对界定哪些专科提供初级保健以及开发评估初级保健服务提供情况的工具更感兴趣。
利用1985 - 1991年全国门诊医疗调查的数据，作者研究了29个医师专科组的活动，以确定近期医学研究所对初级保健的定义是否可行。确定了十个要素，涉及全面性（首诊护理、赫芬达尔指数、因其他问题的既往就诊、预防以及全生命周期护理）、协调性（转诊）、连续性（任何既往就诊）和可及性（为黑人患者、医疗补助计划受益人和农村地区患者提供的护理）。
主成分分析和因子分析表明，除全生命周期护理外，每个要素都对初级保健的构成有贡献。主成分分析能够根据各专科的“初级保健程度”进行排序，这表明除家庭/全科医学、儿科学和内科学之外的专科对初级保健也有重大贡献。因子分析表明，与过程和内容相关的两个因素是初级保健定义的基础，并强调了所提供服务整合的重要性。该分析为进一步开展实证工作以制定初级保健绩效衡量标准提供了基础。
需要对全国性调查进行修改，以便对美国的初级保健进行更全面的评估。
