Roos N P, Carrière K C, Friesen D
Canadian Institute for Advanced Research.
CMAJ. 1998 Oct 6;159(7):777-83.
As part of a recent project focused on needs-based planning for generalist physicians, the authors documented the variety of practice styles of primary care physicians for managing patients with hypertension. They investigated the validity of various explanations for these different styles and the relative contributions of physician and patient characteristics to the rates at which hypertensive patients contact physicians.
Retrospective descriptive study using regression analyses to simultaneously adjust for the influence of key patient and physician characteristics. Hypertensive patients in Winnipeg were identified using Manitoba physician claims data for fiscal years 1993/94 and 1994/95. Patients were included if they were 25 years of age or more and had at least one physician contact in both 1993/94 and 1994/95 during which hypertension was diagnosed. In addition, the primary care physician had to be the physician that the patient contacted most frequently in 1993/94 and 1994/95 and with whom she or he had at least 2 visits during this period. Only patients of family practitioners whose practice included at least 50 hypertensive patients were included.
To control for the effects of large samples and to validate the results, the authors conducted all analyses for half (6282) the sample of hypertensive patients who met the study criteria (12,563). A total of 132 primary care physicians who met the study criteria were identified. The patients made on average 9.3 ambulatory visits to physicians (both general practitioners and specialists) in 1994/95. Those who had more complex medical conditions (i.e., were formally referred to a specialist), those who had 3 or more serious medical problems and those who had been admitted to hospital made more visits to their primary care physician than those without these characteristics. After these and other key patient characteristics were controlled for, a primary care physician's patient recall rate in 1993/94 was strongly related to the number of visits his or her hypertensive patients made to all doctors for any reason in 1994/95. Physicians with high patient recall rates (i.e., who saw their hypertensive patients on average 8 or more times) in 1993/94 also had high recall rates in 1994/95.
Because patient characteristics most strongly associated with high visit rates were those reflecting patient illness, policy measures aimed at patients (e.g., user fees and deinsurance) do not appear to be the appropriate policy tool for dealing with high visit rates. Given the influence of a physician's patient recall rate on patient visit patterns, physician profiling and feedback may prove more appropriate.
作为近期一项专注于通科医生需求规划项目的一部分，作者记录了初级保健医生管理高血压患者的多种执业风格。他们调查了对这些不同风格的各种解释的有效性，以及医生和患者特征对高血压患者联系医生频率的相对影响。
采用回顾性描述性研究，通过回归分析同时调整关键患者和医生特征的影响。利用1993/94和1994/95财政年度马尼托巴省医生索赔数据识别温尼伯的高血压患者。纳入年龄在25岁及以上、在1993/94和1994/95期间至少有一次医生接触且被诊断为高血压的患者。此外，初级保健医生必须是患者在1993/94和1994/95期间联系最频繁且在此期间至少就诊2次的医生。仅纳入其执业中至少有50名高血压患者的家庭医生的患者。
为控制大样本的影响并验证结果，作者对符合研究标准的高血压患者样本（12563例）的一半（6282例）进行了所有分析。共确定了132名符合研究标准的初级保健医生。患者在1994/95年平均看医生（包括全科医生和专科医生）9.3次。那些有更复杂医疗状况（即被正式转诊至专科医生）、有3种或更多严重医疗问题以及曾住院的患者比没有这些特征的患者更频繁地拜访他们的初级保健医生。在控制了这些及其他关键患者特征后，1993/94年初级保健医生的患者召回率与他或她的高血压患者在1994/95年因任何原因看所有医生的次数密切相关。1993/94年患者召回率高（即其高血压患者平均就诊8次或更多次）的医生在1994/95年召回率也高。
由于与高就诊率最密切相关的患者特征是反映患者病情的特征，针对患者的政策措施（如使用费和取消保险）似乎不是应对高就诊率的合适政策工具。考虑到医生的患者召回率对患者就诊模式的影响，医生概况分析和反馈可能更合适。
