Flocke S A, Stange K C, Zyzanski S J
Department of Family Medicine, Cancer Research Center, Case Western Reserve University, Cleveland, OH 44106, USA.
Med Care. 1998 Aug;36(8 Suppl):AS21-30. doi: 10.1097/00005650-199808001-00004.
Evidence is building that primary care is associated with quality of care and cost effectiveness. Still, little is known of the contribution of specific attributes of primary care to important health outcomes, such as the delivery of preventive services. This study tests the association of specific attributes of primary care with a comprehensive measure of the delivery of preventive services.
A cross-sectional multimethod study design was used to examine 2,889 patient visits to 138 community-based primary care physicians. Four primary care attributes were measured: patient preference for their regular physician, interpersonal communication, physician's accumulated knowledge of the patient, and coordination of care. Delivery of US Preventive Service Task Force-recommended services were based on data collected from direct observation and medical record review. Hierarchical linear regression models (HLM) were used to test the association of each of the primary care attributes with being up to date on screening, immunization, and health habit counseling preventive services. Each regression model was adjusted for patient age, race, health status, and insurance type.
Interpersonal communication and coordination of care scale scores were associated with being more up to date on screening services and health habit counseling. Accumulated knowledge and preference for regular physician were associated with being more up to date on immunizations.
The attributes of primary care measured in this study are associated with the receipt of preventive services. Fostering the tenets of primary care may have an impact on the delivery of preventive services and possibly other important health outcomes.
越来越多的证据表明，初级保健与医疗质量和成本效益相关。然而，对于初级保健的特定属性对重要健康结果（如预防服务的提供）的贡献，我们所知甚少。本研究测试了初级保健的特定属性与预防服务提供的综合指标之间的关联。
采用横断面多方法研究设计，对138名社区初级保健医生的2889次患者就诊进行了检查。测量了四个初级保健属性：患者对其常规医生的偏好、人际沟通、医生对患者的累积了解以及护理协调。美国预防服务工作组推荐服务的提供基于从直接观察和病历审查中收集的数据。使用分层线性回归模型（HLM）测试每个初级保健属性与筛查、免疫接种和健康习惯咨询预防服务最新情况之间的关联。每个回归模型都根据患者年龄、种族、健康状况和保险类型进行了调整。
人际沟通和护理协调量表得分与筛查服务和健康习惯咨询的更新程度更高相关。累积知识和对常规医生的偏好与免疫接种的更新程度更高相关。
本研究中测量的初级保健属性与预防服务的接受相关。促进初级保健的原则可能会对预防服务的提供以及可能的其他重要健康结果产生影响。
