Short report: Scope of family practice in rural and urban settings.
Short report: Scope of family practice in rural and urban settings.
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简短报告：农村和城市环境中的家庭实践范围。
DOI：
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发表时间：
2004
期刊：
影响因子：
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通讯作者：
S. Slade
中科院分区：
文献类型：
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作者：
P. Hutten;R. Pitblado;S. Slade
家庭医生在所有环境中提供各种各样的程序。1，2乡村医生往往比城市医生提供更多或更多样的程序。1，2尚未得到很好研究的是，在农村和城市连续体中，实践模式存在差异，以及导致差异的变量的相对重要性。我们的假设是，地理位置是执业范围的主要预测因素，可能比医生的年龄更重要1，3本研究的主要数据来源是1997年加拿大家庭医生学院的全国家庭医生调查。4通过对16个关于程序的问题和8个关于程序的问题中的每一个的调查答复进行总计，计算出实践广度得分。呼叫活动。实践的地理位置确定使用的邮政编码提供的2981个受访者匹配1996年人口普查数据和地理。直线距离计算的实践位置和最近的医院和社区的各种规模。实践广度评分采用独立变量建模：性别、年龄、实践类型、到大型转诊医院（>299张床位）的直线距离、城市人口规模和一般地区（大西洋、魁北克、安大略、大草原、阿尔伯塔、不列颠哥伦比亚省、北方）。多因素Logistic回归分析确认变量的独立性，并确定各参数在确定总练习广度得分中的相对权重。进行平方和分析以确定模型与实践宽度中观察到的变化的拟合程度。在较小的中心，24项程序和随叫随到项目中有21项更为常见（表1）。当所有24个项目合并在实践广度评分中时，注意到与大城市（> 10万人口）的距离增加相关的进展（图1）。一个多元统计模型的基础上的因素，性别，年龄，实践类型，距离大医院，城市人口和地区被发现解释38%的变化，实践广度得分。与实践广度的Pearson相关性在到大型医院的距离（0.401，P < .01）、社区规模（-0.363，P < .01）和地区（0.184，P < .01）等地理变量中最强，这些变量加起来占变异的30%。另外8%的实践广度的变化是由性别（0.172，P < .01），年龄（-0.123，P < .01）和医疗实践类型（-0.083，P < .01）的个人特征解释的。我们的分析表明，随着地理隔离的增加，加拿大家庭医生提供越来越广泛的服务。我们的研究证实了早期的工作，即男性，3年轻的医生，1，2和FP组的做法5与增加的实践广度。聚焦博士Hutten-Czapski是一个家庭医生在农村实践在海利伯里，安大略省。他是渥太华大学和北方安大略医学院的助理教授。皮特布拉多博士是安大略省萨德伯里市劳伦特大学的地理学教授。斯莱德先生是加拿大健康信息研究所的研究顾问。
amily physicians in all settings provide a variety of procedures.1,2 Rural doctors tend to provide a greater number or variety of procedures than their urban counterparts.1,2 What has not been studied well is where practice patterns diff er on the rural-urban continuum and the relative importance of variables that contribute to the diff erences. Our hypothesis was that geography is the predominant predictor of scope of practice and might be a more signifi cant predictor than physicians’ age1,2 or sex.3 Primary data source for this study was the 1997 College of Family Physicians of Canada’s National Family Physician Survey.4 A practice breadth score was calculated by totaling the survey responses from each of 16 questions on procedures and eight on on-call activities. Geographic location of practices was determined using the postal codes provided by the 2981 respondents matched with 1996 census data and geography. Straight-line distances were computed between practice location and nearest hospitals and communities of various sizes. Th e practice breadth score was modeled using independent variables: sex, age, practice type, straight-line distance to large referral hospital (>299 beds), municipal population size, and general region (Atlantic, Quebec, Ontario, Prairies, Alberta, British Columbia, Northern). Multivariate logistic regression was done to confi rm independence of variables and to determine the relative weight of each parameter in determining the total practice breadth score. A sum of squares analysis was done to determine how close the model fi t to observed variation in practice breadth. In smaller centres, 21 of the 24 procedures and on-call items were found to be more common (Table 1). When all 24 items were combined in the practice breadth score, a progression (Figure 1) was noted in association with increasing distance from a large city (>100 000 population). A multivariate statistical model based on factors of sex, age, practice type, distance to large hospital, municipal population, and region was found to explain 38% of the variation in practice breadth score. Pearson correlates to practice breadth were strongest for the geographic variables of distance to large hospital (0.401, P < .01), community size (-0.363, P < .01) and region (0.184, P < .01), which together accounted for 30% of the variation. An additional 8% of the variation in practice breadth was explained by personal characteristics of sex (0.172, P < .01), age (-0.123, P < .01), and type of medical practice (-0.083, P < .01). Our analyses suggest that, as geographic isolation increases, Canadian family physicians provide an increasingly broad spectrum of services. Our study confi rms earlier work that male sex,3 youth of physician,1,2 and FP group practice5 are associated with increased breadth of practice. Focusing Dr Hutten-Czapski is a family physician in rural practice in Haileybury, Ont. He is an Assistant Professor at the University of Ottawa and at the Northern Ontario School of Medicine. Dr Pitblado is a Professor of Geography at Laurentian University in Sudbury, Ont. Mr Slade is a research consultant at the Canadian Institute for Health Information.