Factors influencing the frequency of visits by hypertensive patients to primary care physicians in Winnipeg.
Factors influencing the frequency of visits by hypertensive patients to primary care physicians in Winnipeg.
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发表时间：
1998-10
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通讯作者：
N. Roos;K. Carriere;D. Friesen
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作者：
N. Roos;K. Carriere;D. Friesen
背景作为最近一个项目的一部分，重点是全科医生的需求为基础的规划，作者记录了初级保健医生管理高血压患者的各种实践风格。他们调查了对这些不同类型的各种解释的有效性，以及医生和患者特征对高血压患者联系医生的比率的相对贡献。方法回顾性描述性研究，采用回归分析，同时调整的影响，关键病人和医生的特点。高血压患者在温尼伯确定使用马尼托巴医生索赔数据1993/94和1994/95财政年度。如果患者年龄在25岁或以上，并且在1993/94和1994/95年诊断为高血压期间至少有一名医生联系，则将其纳入。此外，初级保健医生必须是患者在1993/94年和1994/95年最常联系的医生，并且在此期间至少有两次就诊。仅纳入家庭医生的患者，其实践包括至少50名高血压患者。结果为了控制大样本的影响并验证结果，作者对符合研究标准（12，563）的一半（6282）高血压患者样本进行了所有分析。共有132名符合研究标准的初级保健医生被确定。1994/1995年，病人平均到医生（全科医生和专科医生）门诊9.3次。那些有更复杂的医疗条件的人（即，正式转介给专科医生），那些有3个或更多严重的医疗问题和那些已经住院的人比那些没有这些特征的人更多地去看他们的初级保健医生。在控制了这些和其他关键的患者特征后，初级保健医生在1993/94年的患者回忆率与他或她的高血压患者在1994/95年因任何原因向所有医生就诊的次数密切相关。患者回忆率高的医生（即，1994/95年的回忆率也很高。由于与高就诊率最密切相关的患者特征是那些反映患者疾病的特征，因此针对患者的政策措施（例如，使用费和取消保险）似乎不是处理高就诊率的适当政策工具。考虑到医生的患者回忆率对患者就诊模式的影响，医生分析和反馈可能更合适。
BACKGROUND As part of a recent project focused on needs-based planning for generalist physicians, the authors documented the variety of practice styles of primary care physicians for managing patients with hypertension. They investigated the validity of various explanations for these different styles and the relative contributions of physician and patient characteristics to the rates at which hypertensive patients contact physicians. METHODS Retrospective descriptive study using regression analyses to simultaneously adjust for the influence of key patient and physician characteristics. Hypertensive patients in Winnipeg were identified using Manitoba physician claims data for fiscal years 1993/94 and 1994/95. Patients were included if they were 25 years of age or more and had at least one physician contact in both 1993/94 and 1994/95 during which hypertension was diagnosed. In addition, the primary care physician had to be the physician that the patient contacted most frequently in 1993/94 and 1994/95 and with whom she or he had at least 2 visits during this period. Only patients of family practitioners whose practice included at least 50 hypertensive patients were included. RESULTS To control for the effects of large samples and to validate the results, the authors conducted all analyses for half (6282) the sample of hypertensive patients who met the study criteria (12,563). A total of 132 primary care physicians who met the study criteria were identified. The patients made on average 9.3 ambulatory visits to physicians (both general practitioners and specialists) in 1994/95. Those who had more complex medical conditions (i.e., were formally referred to a specialist), those who had 3 or more serious medical problems and those who had been admitted to hospital made more visits to their primary care physician than those without these characteristics. After these and other key patient characteristics were controlled for, a primary care physician's patient recall rate in 1993/94 was strongly related to the number of visits his or her hypertensive patients made to all doctors for any reason in 1994/95. Physicians with high patient recall rates (i.e., who saw their hypertensive patients on average 8 or more times) in 1993/94 also had high recall rates in 1994/95. INTERPRETATION Because patient characteristics most strongly associated with high visit rates were those reflecting patient illness, policy measures aimed at patients (e.g., user fees and deinsurance) do not appear to be the appropriate policy tool for dealing with high visit rates. Given the influence of a physician's patient recall rate on patient visit patterns, physician profiling and feedback may prove more appropriate.