Gross R, Tabenkin H, Bramli S, Schvartzman P
JDC-Brookdale Institute, Jerusalem.
Harefuah. 1998 Jan 15;134(2):81-8, 160.
Patients' opinions of the role of the primary care physician were studied. The study population consisted of Hebrew-speaking members of the Clalit Sick Fund, aged 18+, who visited primary care and specialty clinics. Interviews took place during January-March 1995 in the Emek and Jerusalem, and during August-October 1995 in Beer Sheba. A total of 2,734 interviews were conducted, and the response rate was 88%. 64% of the respondents preferred the primary care physician as the first address for most problems occurring during the day. Multivariate analysis revealed that the variables predicting this reference were: being over age 45, having completed less than 12 years of schooling, being satisfied with the physician, and when a child's illness was involved. Whether the physician was a specialist had only a marginal effect. The findings also show that among those who did go directly to a specialist for the current visit, 49% would still prefer the primary care physician to be the first address for most problems. However, half of the respondents initiated the current visit to the specialty clinic themselves. The findings also showed that a preference for the primary care physician to be the first address had an independent and statistically significant effect on the following aspects of service consumption: taking the initiative to go to a specialist, the intention to return to the primary care physician or to the specialist for continuing care, and the patient's belief that referral to a specialist was needed. The findings of the study may be of assistance to policy-makers on the national level and to sick funds in planning the role of the primary care physician, so that it corresponds, on the one hand, to the needs of the sick funds and the economic constraints in the health system, and on the other, to the preferences of the patient.
研究了患者对初级保健医生角色的看法。研究对象为Clalit疾病基金中讲希伯来语、年龄在18岁及以上、就诊于初级保健和专科诊所的成员。访谈于1995年1月至3月在埃梅克和耶路撒冷进行，1995年8月至10月在贝尔谢巴进行。共进行了2734次访谈，回复率为88%。64%的受访者更倾向于将初级保健医生作为白天出现的大多数问题的首选咨询对象。多变量分析显示，预测这种咨询倾向的变量包括：年龄超过45岁、受教育年限少于12年、对医生满意以及涉及儿童疾病。医生是否为专科医生的影响较小。研究结果还表明，在本次就诊直接去找专科医生的人中，49%仍然更希望初级保健医生是大多数问题的首选咨询对象。然而，一半的受访者是自行前往专科诊所就诊的。研究结果还表明，倾向于将初级保健医生作为首选咨询对象对服务消费的以下方面有独立且具有统计学意义的影响：主动去看专科医生、返回初级保健医生或专科医生处接受持续护理的意愿以及患者认为需要转诊至专科医生的信念。该研究结果可能有助于国家层面的政策制定者以及疾病基金规划初级保健医生的角色，使其一方面符合疾病基金的需求和卫生系统的经济限制，另一方面符合患者的偏好。
