Keating N L, Zaslavsky A M, Ayanian J Z
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.
JAMA. 1998 Sep 9;280(10):900-4. doi: 10.1001/jama.280.10.900.
Efforts to control medical expenses by emphasizing primary care and limiting specialty care may influence how physicians use informal or "curbside" consultation.
To understand physicians' use of and beliefs about informal consultation.
Survey mailed in July 1997.
Of a random sample of Massachusetts general internists, pediatricians, cardiologists, orthopedic surgeons (n=300 each), and infectious disease specialists (n=200) surveyed, 1225 were eligible and 705 (58%) responded.
Self-reported use of and beliefs about informal consultation.
Generalist physicians requested more informal consultations than specialists (median, 3 vs 1 per week; P<.001) and were asked to provide fewer (2 vs 5 per week; P<.001). In multivariate analyses, physicians in a health maintenance organization, multispecialty group, or single-specialty group requested more informal consultations than those in solo practice (82%, 40%, and 28% more, respectively; all P<.001) and were more often asked to provide them (43%, 63%, and 14% more, respectively; all P<.05). Physicians with at least 30% of their income from capitation requested 38% more and were asked to provide 46% more informal consultations than those with little or no income from capitation (both P<.001). Generalists' overall approval of informal consultation was greater than specialists' (mean 5.9 vs 5.1 on a 7-point Likert scale; P<.001), and approval was strongly associated with beliefs about how informal consultation affects quality of care (P<.001).
Use of informal consultation is common, varies by specialty, practice setting, and capitation, and therefore may increase with current trends toward group practice and managed care. Because overall approval of informal consultation is strongly associated with beliefs about how it affects quality of care, this issue should be carefully considered by physicians who participate in informal consultation.
通过强调初级保健和限制专科护理来控制医疗费用的努力可能会影响医生使用非正式或“路边”会诊的方式。
了解医生对非正式会诊的使用情况和看法。
1997年7月邮寄的调查问卷。
在对马萨诸塞州普通内科医生、儿科医生、心脏病专家、骨科医生（各300名）和传染病专家（200名）进行的随机抽样调查中，1225人符合条件，705人（58%）做出了回应。
自我报告的非正式会诊使用情况和看法。
全科医生比专科医生要求更多的非正式会诊（中位数，每周3次对1次；P<0.001），而被要求提供的非正式会诊更少（每周2次对5次；P<0.001）。在多变量分析中，健康维护组织、多专科组或单专科组的医生比独立执业的医生要求更多的非正式会诊（分别多82%、40%和28%；均P<0.001），并且更常被要求提供非正式会诊（分别多43%、63%和14%；均P<0.05）。收入至少30%来自按人头付费的医生比收入很少或没有来自按人头付费收入的医生要求多38%的非正式会诊，并且被要求提供多46%的非正式会诊（均P<0.001）。全科医生对非正式会诊的总体认可程度高于专科医生（在7分李克特量表上平均为5.9对5.1；P<0.001），并且认可程度与对非正式会诊如何影响医疗质量的看法密切相关（P<0.001）。
非正式会诊的使用很常见，因专科、执业环境和按人头付费情况而异，因此可能会随着当前向团体执业和管理式医疗的趋势而增加。由于对非正式会诊的总体认可程度与对其如何影响医疗质量的看法密切相关，参与非正式会诊的医生应仔细考虑这个问题。
