Performance of primary care physicians and other providers on key process measures in the treatment of diabetes.
Performance of primary care physicians and other providers on key process measures in the treatment of diabetes.
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DOI：
10.2337/dc12-1382
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发表时间：
2013-05
期刊：
影响因子：
16.2
通讯作者：
Turchin A
中科院分区：
文献类型：
--
作者：
Morrison F;Shubina M;Goldberg SI;Turchin A
研究表明，没有始终如一的初级保健提供者的患者预后较差。然而，人们对这些效应的机制知之甚少。这项研究旨在确定初级保健医生(PCP)是否比初级保健环境中的其他提供者提供更频繁的药物强化、生活方式咨询和患者接触。这项回顾性队列研究包括27,225名糖尿病患者的584,587次就诊，这些患者至少监测了2年的糖化血红蛋白、血压和/或低密度脂蛋白胆固醇升高。相遇发生在马萨诸塞州东部两家教学医院附属的初级保健诊所。在记录的接触中，83%是与PCP，13%是与覆盖的医生，5%是与中层提供者。在多变量分析中，PCP的药物强化治疗的几率比覆盖医生和中层提供者的分别高49%(P<；0.0001)和26%(P<；0.0001)，而生活方式咨询的几率分别高91%(P<；0.0001)和21%(P=0.0015)。在有急性主诉的就诊期间，覆盖的医生更不可能加强药物治疗(P<；0.0001)，而中层提供者提供生活方式咨询的可能性更低(41%)(P<；0.0001)。与PCP相比，在没有急性症状的情况下就诊后到下一次接触的时间的风险比，覆盖内科医生的风险比为1.11，中等水平提供者的风险比为1.19(P<；两者均为0.0001)。初级保健医生通过更高比率的药物强化治疗和生活方式咨询提供更好的护理。覆盖医生和中层提供者可能会在PCP资源受限时实现更频繁的接触。
Studies have shown that patients without a consistent primary care provider have inferior outcomes. However, little is known about the mechanisms for these effects. This study aims to determine whether primary care physicians (PCPs) provide more frequent medication intensification, lifestyle counseling, and patient encounters than other providers in the primary care setting. This retrospective cohort study included 584,587 encounters for 27,225 patients with diabetes and elevated A1C, blood pressure, and/or LDL cholesterol monitored for at least 2 years. Encounters occurred at primary care practices affiliated with two teaching hospitals in eastern Massachusetts. Of the encounters documented, 83% were with PCPs, 13% were with covering physicians, and 5% were with midlevel providers. In multivariable analysis, the odds of medication intensification were 49% (P < 0.0001) and 26% (P < 0.0001) higher for PCPs than for covering physicians and midlevel providers, respectively, whereas the odds of lifestyle counseling were 91% (P < 0.0001) and 21% (P = 0.0015) higher. During visits with acute complaints, covering physicians were even less likely, by a further 52% (P < 0.0001), to intensify medications, and midlevel providers were even less likely, by a further 41% (P < 0.0001), to provide lifestyle counseling. Compared with PCPs, the hazard ratios for time to the next encounter after a visit without acute complaints were 1.11 for covering physicians and 1.19 for midlevel providers (P < 0.0001 for both). PCPs provide better care through higher rates of medication intensification and lifestyle counseling. Covering physicians and midlevel providers may enable more frequent encounters when PCP resources are constrained.
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影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
7.2
作者：
Klabunde, CN;Potosky, AL;Warren, JL
通讯作者：
Warren, JL
影响因子：
3.4
作者：
Berlowitz, DR;Ash, AS;Wong, AT
通讯作者：
Wong, AT
影响因子：
120.7
作者：
Hauer, Karen E.;Durning, Steven J.;Schwartz, Mark D.
通讯作者：
Schwartz, Mark D.
影响因子：
--
作者：
Morrison, Fritha;Shubina, Maria;Turchin, Alexander
通讯作者：
Turchin, Alexander