Ingram C J, O'Brien-Gonzales A, Main D S, Barley G, Westfall J M
University of Leiden, College of Medicine, The Netherlands.
J Fam Pract. 1999 Jan;48(1):62-5.
Visiting patients at home has long been one of the activities of the family physician, but the practice of making house calls has diminished significantly during the second half of the 20th century. The goal of this study was to describe physicians' attitudes about house calls and their practice of making them in the rapidly changing health care environment of the United States.
A 30-item, self-administered questionnaire was designed to obtain demographic information about physicians and their attitudes toward house calls, practice experiences with making house calls, and any additional factors that influence making house calls. It was mailed to all members of the Colorado Academy of Family Physicians, during the summer of 1997.
A 66% response rate was obtained from practicing physicians. Overall attitudes toward house calls were positive. Fifty-three percent of the respondents reported making house calls, and 8% reported making more than 2 house calls per month. Male physicians, those older than 40 years, those in rural settings, and those trained in a community-based residency were more likely to make house calls. Patient payer mix and practice setting were also related to whether a physician made house calls. House calls were most frequently made to geriatric patients, cancer patients, trauma patients, and patients with transportation difficulties. Many physicians reported using home health agencies for assessment and treatment of patients needing home care.
Family physicians agree that house calls are good for patients. More than half of the respondents reported that they occasionally make house calls. However, few physicians routinely perform house calls.
上门访视患者长期以来一直是家庭医生的工作内容之一,但在20世纪后半叶,上门出诊的做法已大幅减少。本研究的目的是描述在美国快速变化的医疗环境中,医生对上门出诊的态度及其出诊实践情况。
设计了一份包含30个条目的自填式问卷,以获取医生的人口统计学信息、他们对上门出诊的态度、上门出诊的实践经验以及任何影响上门出诊的其他因素。1997年夏天,该问卷被邮寄给科罗拉多家庭医生学会的所有成员。
执业医生的回复率为66%。对上门出诊的总体态度是积极的。53%的受访者报告进行过上门诊治,8%的受访者报告每月上门出诊超过2次。男性医生、年龄超过40岁的医生、在农村地区工作的医生以及接受过社区住院医师培训的医生更有可能上门出诊。患者付费类型和执业环境也与医生是否上门出诊有关。上门出诊最常针对老年患者、癌症患者、创伤患者以及有交通困难的患者。许多医生报告使用家庭健康机构对需要居家护理的患者进行评估和治疗。
家庭医生一致认为上门出诊对患者有益。超过一半的受访者报告他们偶尔会上门出诊。然而,很少有医生经常进行上门出诊。