Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from, three national surveys
Diagnostic scope of and exposure to primary care physicians in Australia, New Zealand, and the United States: cross sectional analysis of results from, three national surveys
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DOI：
10.1136/bmj.39203.658970.55
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发表时间：
2007-06-16
影响因子：
105.7
通讯作者：
Majeed, Azeem
中科院分区：
文献类型：
--
作者：
Bindman, Andrew B.;Forrest, Christopher B.;Majeed, Azeem
目的比较混合的患者，执业范围，并在初级保健医生在澳大利亚，新西兰，和United.Design三个可比的横截面调查在2001-2访问的持续时间。医生完成了一份关于患者人口统计学、诊断和就诊时间的调查问卷。设置初级保健实践。参与者79 790例澳大利亚门诊就诊，10 064例新西兰门诊就诊，25 838例美国门诊就诊。主要结果测量诊断代码映射到约翰霍普金斯扩展诊断群。实践范围被定义为扩展诊断集群的数量，占所有与发病率相关的管理问题的75%。暴露于初级保健的医生记录的访问时间计算，并报告的访问率初级保健为each country.Results在每个国家，初级保健医生管理的平均1.4发病率相关的问题，每次访问。在美国，46个扩展诊断集群占管理问题的75%，而澳大利亚为52%，新西兰为57。国家之间管理的卫生问题频率的相关性很高（成对比较为0.87-0.97）。尽管美国的初级保健就诊时间比新西兰和澳大利亚长，在美国，（29.7分钟）大约是新西兰的一半（55.5分钟），澳大利亚约为三分之一（83.4分）因为这些国家的初级保健就诊率较高。结论尽管各国初级保健的供应和筹资存在差异，在澳大利亚、新西兰和美国，初级保健医生的临床实践的许多方面非常相似。
Objective To compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States.Design Comparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit.Setting Primary care practice.Participants 79 790 office Visits in Australia, 10 064 in New Zealand, and 25 838 in the US.Main outcome measures Diagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country.Results In each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 5 2 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries.Conclusions Despite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.