Introduction of the patient-list system in general practice - Changes in Norwegian physicians' perception of their gatekeeper role
Introduction of the patient-list system in general practice - Changes in Norwegian physicians' perception of their gatekeeper role
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DOI：
10.1080/02813430310004155
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发表时间：
2003-12-01
影响因子：
2.1
通讯作者：
Norheim, OF
中科院分区：
文献类型：
--
作者：
Carlsen, B;Norheim, OF
目的-探讨最近在全科实践中引入的患者名单系统是否影响了全科医生（GP）作为看门人的自我认知。设计-对全科医生进行结构化焦点小组访谈和一份简短的自填问卷。设置-挪威公共卫生保健系统内的初级保健。 2001年6月引入患者名单制度后6个月至1年进行小组访谈。对象——参加辅导小组或专家继续教育小组的81名全科医生。结果衡量——通过11次小组讨论记录、转录和系统分析全科医生的改革经验，通过编码和提取知情人的陈述。问卷提供了每个参与者的背景信息。结果——医生普遍认为自己不太关心新系统下的看门人角色。他们认为提供更好的服务并让患者满意更为重要。从业者用三个背景因素解释了这种转变：竞争加剧且更加明显、患者的期望更高以及赋予全科医生更多的责任。 结论——挪威的全科医生经历了医患关系中权力的转变，有利于患者。全科医生的看门人角色意识已经减弱。我们质疑新系统是否削弱了决策中考虑资源使用的动力。
Objective-To explore whether the patient-list system, recently introduced in general practice, has influenced general practitioners' (GPs') self-perception as gatekeepers.Design-Structured focus group interviews with GPs and a short self-administered questionnaire.Setting-Primary care within the public health care system in Norway. Group interviews were conducted 6 months to 1 year after the patient-list system was introduced in June, 2001.Subjects-81 GPs attending tutorial groups or specialists' continuous education groups.Outcome measures-GPs' experience with the reform as stated in 11 group discussions, recorded, transcribed and systematically analysed through coding and extracting of the informants' statements. The questionnaire provided background information about each participant.Results-The doctors generally perceived themselves as less concerned with the gatekeeper role under the new system. They felt it more important to provide better services and keep patients satisfied. The practitioners explained this shift using three contextual factors: increased and more visible competition, higher expectations from the patients and more responsibility assigned to the GP.Conclusion-GPs in Norway have experienced a shift in power in the physician-patient relationship favouring the patient. The GP's consciousness of the gatekeeper role has diminished. We question whether the new system lessens the incentive to consider resource use in decision-making.