Overtreatment in the United States.
Overtreatment in the United States.
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DOI：
10.1371/journal.pone.0181970
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Makary MA
中科院分区：
文献类型：
--
作者：
Lyu H;Xu T;Brotman D;Mayer-Blackwell B;Cooper M;Daniel M;Wick EC;Saini V;Brownlee S;Makary MA
过度治疗是造成可预防的伤害和医疗保健浪费的一个原因。临床医生对这一问题的看法知之甚少。在这项研究中，医生对过度治疗的流行率、原因和影响进行了调查。来自美国医学会(AMA)Masterfile医生组成的在线社区的2106名医生参与了一项调查。这项调查询问了过度使用的程度，以及原因、解决方案和对医疗保健的影响。主要观察指标包括：不必要医疗护理的百分比、最常提到的过度治疗原因、可能的解决方案以及与利润和过度治疗相关的反应。有效率为70.1%。医生报告说，插入的中位数20.6%的整体医疗保健是不必要的，包括22.0%的处方药，24.9%的检查和11.1%的程序。最常见的过度治疗原因是担心医疗事故(84.7%)、患者压力/要求(59.0%)和难以获取医疗记录(38.2%)。确定的潜在解决方案是对住院医生进行适当性标准培训(55.2%)，方便获取外部健康记录(52.0%)，以及更多实践指南(51.5%)。大多数受访者(70.8%)认为，当医生从中获利时，他们更有可能进行不必要的手术。大多数受访者认为，不强调按服务收费的医生补偿将降低医疗保健的利用率和成本。从医生的角度来看，过度治疗是很常见的。解决这一问题的努力应该考虑医生提供的原因和解决方案。
Overtreatment is a cause of preventable harm and waste in health care. Little is known about clinician perspectives on the problem. In this study, physicians were surveyed on the prevalence, causes, and implications of overtreatment. 2,106 physicians from an online community composed of doctors from the American Medical Association (AMA) masterfile participated in a survey. The survey inquired about the extent of overutilization, as well as causes, solutions, and implications for health care. Main outcome measures included: percentage of unnecessary medical care, most commonly cited reasons of overtreatment, potential solutions, and responses regarding association of profit and overtreatment. The response rate was 70.1%. Physicians reported that an interpolated median of 20.6% of overall medical care was unnecessary, including 22.0% of prescription medications, 24.9% of tests, and 11.1% of procedures. The most common cited reasons for overtreatment were fear of malpractice (84.7%), patient pressure/request (59.0%), and difficulty accessing medical records (38.2%). Potential solutions identified were training residents on appropriateness criteria (55.2%), easy access to outside health records (52.0%), and more practice guidelines (51.5%). Most respondents (70.8%) believed that physicians are more likely to perform unnecessary procedures when they profit from them. Most respondents believed that de-emphasizing fee-for-service physician compensation would reduce health care utilization and costs. From the physician perspective, overtreatment is common. Efforts to address the problem should consider the causes and solutions offered by physicians.
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影响因子：
120.7
作者：
Chan, Paul S.;Patel, Manesh R.;Klein, Lloyd W.;Krone, Ronald J.;Dehmer, Gregory J.;Kennedy, Kevin;Nallamothu, Brahmajee K.;Weaver, W. Douglas;Masoudi, Frederick A.;Rumsfeld, John S.;Brindis, Ralph G.;Spertus, John A.
通讯作者：
Spertus, John A.
影响因子：
--
作者：
Hecker, MT;Aron, DC;Donskey, CJ
通讯作者：
Donskey, CJ
"不必要的 "脊柱手术： 一位外科医生为期一年的前瞻性经验研究。
影响因子：
--
作者：
Epstein, Nancy E;Hood, Donald C
通讯作者：
Hood, Donald C
影响因子：
3
作者：
Lammers, Eric J.;Adler-Milstein, Julia;Kocher, Keith E.
通讯作者：
Kocher, Keith E.
影响因子：
9.7
作者：
Lee, Thomas H.;Bothe, Albert;Steele, Glenn D.
通讯作者：
Steele, Glenn D.