Estimated time spent on preventive services by primary care physicians
Estimated time spent on preventive services by primary care physicians
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DOI：
10.1186/1472-6963-8-245
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发表时间：
2008-12-01
影响因子：
2.8
通讯作者：
Ostbye, Truls
中科院分区：
文献类型：
--
作者：
Pollak, Kathryn I.;Krause, Katrina M.;Ostbye, Truls
背景：在初级保健中缺乏预防性卫生服务。主要障碍之一是缺乏时间。我们估计初级保健医生花费在重要的预防health services.Methods的时间量：我们分析了一个大型数据集的初级保健（家庭和内科）访问使用全国门诊医疗调查（2001-4）;分析进行了2007-8。使用多元线性回归估计的时间花费在提供每一个预防服务，控制人口统计学covariates.Results：预防访问时间长于慢性护理访问（M=22.4，SD=11.8，M=18.9，SD=9.2，分别）。新病人需要更多的时间从医生。医生花费相对较多时间的服务是前列腺特异性抗原（PSA）、胆固醇、巴氏涂片（Pap）、乳房X光检查、运动咨询和血压。医生花在两个“A”级（“良好证据”）服务，戒烟和巴氏涂片（在预防性访问）和一个“B”级（“至少公平证据”）服务，营养咨询的时间少于建议。医生花了大量的时间在两个服务，有一个“I”评级（“不确定的证据的有效性”），PSA和运动consulting.Conclusion：即使时间有限，医生解决许多“A”评级的服务充分。然而，他们可能花费的时间少于建议的重要服务，特别是戒烟，巴氏涂片检查和营养咨询。未来的研究需要了解医生如何决定如何分配他们的时间来解决预防性健康问题。
Background: Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.Methods: We analyzed a large dataset of primary care (family and internal medicine) visits using the National Ambulatory Medical Care Survey (2001-4); analyses were conducted 2007-8. Multiple linear regression was used to estimate the amount of time spent delivering each preventive service, controlling for demographic covariates.Results: Preventive visits were longer than chronic care visits (M=22.4, SD=11.8, M=18.9, SD=9.2, respectively). New patients required more time from physicians. Services on which physicians spent relatively more time were prostate specific antigen (PSA), cholesterol, Papanicolaou (Pap) smear, mammography, exercise counseling, and blood pressure. Physicians spent less time than recommended on two "A" rated ("good evidence") services, tobacco cessation and Pap smear (in preventive visits), and one "B" rated ("at least fair evidence") service, nutrition counseling. Physicians spent substantial time on two services that have an "I" rating ("inconclusive evidence of effectiveness"), PSA and exercise counseling.Conclusion: Even with limited time, physicians address many of the "A" rated services adequately. However, they may be spending less time than recommended for important services, especially smoking cessation, Pap smear, and nutrition counseling. Future research is needed to understand how physicians decide how to allocate their time to address preventive health.