Gulbrandsen P, Fugelli P, Sandvik L, Hjortdahl P
Institute of General Practice and Community Medicine, University of Oslo, PO Box 1130 Blindern, N-0317 Oslo, Norway.
BMJ. 1998 Jul 4;317(7150):28-32. doi: 10.1136/bmj.317.7150.28.
To find how often social problems influence clinical management in general practice, how management is changed, and how the characteristics of patients, doctors, and the doctor-patient relationship influence this management.
Multipractice survey of patients consulting general practitioners. Doctors completed a questionnaire for each patient.
General practices in Buskerud county, Norway.
1401 consecutive adult patients attending 89 general practitioners.
How often management of patients was influenced by different types of social problem and main reasons for consultation; frequency and intercorrelation of different types of management applied; odds ratios for social problems' influence on management, controlled for by characteristics of doctors, patients, and their relationship.
In 17% of all consultations the doctors' knowledge of patients' social problems influenced their management, stressful working conditions being the most frequent influencing type of problem. Knowledge of social problems influenced management more often when the doctor knew a patient well, but less often the longer a doctor had worked in a practice. When social problems influenced management, the commonest types of management offered were extra time for consultation (51%), advice (42%), authorisation of sick leave (28%), and prescription of a psychotropic drug (20%), while referral to community services was used in 2.6% of these consultations. Prescription of a psychotropic drug was positively correlated with use of extra time, and was made more often by female doctors.
Patients' social problems influenced choice of management in at least a sixth of consultations. Prior knowledge of the patient, the doctor's time in present practice, age and sex of the patient, and sex of the doctor significantly influenced management of patients.
了解社会问题在全科医疗中影响临床管理的频率、管理方式如何改变，以及患者、医生和医患关系的特征如何影响这种管理。
对咨询全科医生的患者进行多机构调查。医生为每位患者填写一份问卷。
挪威布斯克吕德郡的全科医疗机构。
连续就诊于89位全科医生的1401名成年患者。
患者管理受不同类型社会问题影响的频率及主要咨询原因；所采用不同类型管理的频率及相互关系；经医生、患者及其关系特征控制后，社会问题对管理影响的比值比。
在所有会诊中，17%的患者其社会问题影响了医生的管理，工作条件压力大是最常影响管理的问题类型。当医生对患者比较了解时，社会问题知识对管理的影响更常见，但医生在某一机构工作时间越长，这种影响越少见。当社会问题影响管理时，最常提供的管理类型是额外的会诊时间（51%）、建议（42%）、病假授权（28%）和开具精神药物处方（20%），而在这些会诊中，转介至社区服务的占2.6%。开具精神药物处方与额外时间的使用呈正相关，且女医生开具的频率更高。
患者的社会问题在至少六分之一的会诊中影响了管理选择。对患者的预先了解、医生在当前机构的工作时间、患者的年龄和性别以及医生的性别显著影响了患者的管理。
