Bertakis K D, Callahan E J, Helms L J, Azari R, Robbins J A, Miller J
Department of Family and Community Medicine, University of California, Davis, Sacramento 95817, USA.
Med Care. 1998 Jun;36(6):879-91. doi: 10.1097/00005650-199806000-00011.
This study compared patient health status, patient satisfaction, and physician practice style between family practice and internal medicine.
New adult patients (n = 509) were prospectively and randomly assigned to family practice or internal medicine clinics at a university medical center and followed for 1 year of care. Practice styles were characterized by the Davis Observation Code. Self-reported health status (Medical Outcomes Study, Short Form-36) and patient satisfaction also were measured.
There were no significantly different changes in self-reported health status or patient satisfaction between family practice and internal medicine physicians during the course of the study. Family practice initial encounters, however, were characterized by a style placing greater relative emphasis on health behavior and counseling, whereas internists used a more technical style. Improved health status scores after treatment were predicted by a practice style emphasis on counseling, whereas improvements in patient satisfaction scores were predicted by a style of care stressing patient activation. Although this is the first known randomized trial studying this issue, the conclusions are limited by a 38% loss of patients from enrollment to care and a loss of 18% at the 1-year follow-up evaluation.
There were significant differences in practice styles between family physicians and internists; however, it was the physician's behavior, not specialty per se, that affected patient outcomes. A practice style emphasizing psychosocial aspects of care was predictive of improvements in patient health status, whereas a practice style emphasizing patient activation was predictive of improvements in patient satisfaction.
本研究比较了家庭医学与内科医学在患者健康状况、患者满意度及医生执业风格方面的差异。
新成年患者（n = 509）被前瞻性随机分配至某大学医学中心的家庭医学或内科诊所，并接受为期1年的治疗。执业风格采用戴维斯观察代码进行描述。同时测量患者自我报告的健康状况（医学结局研究简表-36）及患者满意度。
在研究过程中，家庭医学医生和内科医生在患者自我报告的健康状况或患者满意度方面，均未出现显著差异。然而，家庭医学的初诊以更注重健康行为和咨询的风格为特征，而内科医生则采用更具技术性的风格。以注重咨询的执业风格可预测治疗后健康状况评分的改善，而以强调患者主动参与的护理风格可预测患者满意度评分的改善。尽管这是已知的第一项针对此问题的随机试验，但其结论受到从入组到治疗期间38%的患者流失率以及1年随访评估时18%的流失率的限制。
家庭医生和内科医生在执业风格上存在显著差异；然而，影响患者治疗效果的是医生的行为，而非专业本身。注重护理心理社会方面的执业风格可预测患者健康状况的改善，而强调患者主动参与的执业风格可预测患者满意度的改善。
