Patient Care Outside of Office Visits: A Primary Care Physician Time Study
Patient Care Outside of Office Visits: A Primary Care Physician Time Study
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DOI：
10.1007/s11606-010-1494-7
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发表时间：
2011-01-01
影响因子：
5.7
通讯作者：
Casalino, Lawrence P.
中科院分区：
文献类型：
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作者：
Chen, Melinda A.;Hollenberg, James P.;Casalino, Lawrence P.
背景：由初级保健医生在办公室访问之外提供的病人护理对于护理协调是重要的，并且可以替代办公室访问。目的：描述初级保健医生在办公室访问之外的非卧床患者护理活动(AOV)以及他们对AOV替代访问和可由支持人员执行的程度的看法。设计：横断面直接观察性研究。MAIN测量：按活动类型划分的AOV的持续时间，以及它们是否与研究日的患者探视有关(访问特定)或不访问(非访问特定)。医生对以下方面的看法：(1)非就诊特定的AOV取代了原本会发生的就诊；(2)已发生的就诊可能被AOV取代；(3)支持人员在AOV中的潜在作用。KEY结果：医生每天花费20%的时间进行AOV，其中62%用于非就诊特定的AOV。他们认为，非特定访问的AOV时间的中位数为37%，即每天可能节省5次访问。他们还认为，总AOV时间的15%(不包括图表)可以由支持人员执行。42%的医生表示，研究日内的一次或多次就诊可以被AOV取代。结论：虽然花费在AOV上的时间通常是不报销的，但初级保健普通内科医生花费了大量时间进行AOV，他们认为其中很大一部分是为了取代原本会发生的就诊。支持医生和工作人员在AOV上花费时间的政策可能会降低医疗成本，为患者和医生节省时间，并改善护理协调。
BACKGROUND: Patient care provided by primary care physicians outside of office visits is important for care coordination and may serve as a substitute for office visits.OBJECTIVES: To describe primary care physicians' ambulatory patient care activities outside of office visits ("AOVs") and their perceptions of the extent to which AOVs substitute for visits and may be performed by support staff.DESIGN: Cross-sectional direct observational study.PARTICIPANTS: Thirty-three general internists in 20 practices in two health care systems (one public, one private) in the New York metropolitan area.MAIN MEASURES: Duration of AOVs by type of activity and whether they pertain to a patient visit on the study day (visit specific) or not (non-visit specific). Physician perceptions of the: (1) extent that non-visit-specific AOVs substitute for visits that would have otherwise occurred, (2) extent that visits that occurred could have been substituted for by AOVs, and (3) potential role of support staff in AOVs.KEY RESULTS: Physicians spent 20% of their workday performing AOVs, 62% of which was for non-visit specific AOVs. They perceived that a median of 37% of non-visit-specific AOV time substituted for visits, representing a potential five visits saved per day. They also perceived that 15% of total AOV time (excluding charting) could be performed by support staff. Forty-two percent of physicians indicated that one or more visits during the study day could be substituted for by AOVs.CONCLUSIONS: Though time spent on AOVs is generally not reimbursed, primary care general internists spent significant time performing AOVs, much of which they perceived to substitute for visits that would otherwise have occurred. Policies supporting physician and staff time spent on AOVs may reduce health care costs, save time for patients and physicians, and improve care coordination.