The association of attributes of primary care with the delivery of clinical preventive services
The association of attributes of primary care with the delivery of clinical preventive services
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DOI：
10.1097/00005650-199808001-00004
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发表时间：
1998-08-01
期刊：
影响因子：
3
通讯作者：
Zyzanski, SJ
中科院分区：
文献类型：
--
作者：
Flocke, SA;Stange, KC;Zyzanski, SJ
目标.越来越多的证据表明，初级保健与保健质量和成本效益有关。然而，人们对初级保健的具体属性对重要健康成果的贡献知之甚少，如提供预防服务。本研究测试的关联的具体属性的初级保健与全面的措施，提供预防性服务。采用横断面多方法研究设计，对138名社区初级保健医生的2，889名患者进行了检查。测量了四个初级保健属性：患者对常规医生的偏好、人际沟通、医生对患者的累积知识以及护理协调。提供美国预防服务工作组建议的服务是基于直接观察和病历审查收集的数据。分层线性回归模型（HLM）被用来测试协会的每一个初级保健的属性是最新的筛查，免疫接种和健康习惯咨询预防服务。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。人际沟通和协调护理量表得分与更及时的筛查服务和健康习惯咨询有关。累积的知识和对正规医生的偏好与更及时的免疫接种有关。在这项研究中测量的初级保健的属性与预防服务的接受。促进初级保健的原则可能会对预防服务的提供产生影响，并可能对其他重要的保健成果产生影响。
OBJECTIVES. 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.METHODS. 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.RESULTS. 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.CONCLUSIONS. 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.