Continuity of primary care: to whom does it matter and when?
Continuity of primary care: to whom does it matter and when?
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DOI：
10.1370/afm.63
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发表时间：
2003-09-01
影响因子：
4.4
通讯作者：
Stange, Kurt C
中科院分区：
文献类型：
--
作者：
Nutting, Paul A;Goodwin, Meredith A;Stange, Kurt C
背景：对于连续性护理的价值，不一致的发现可能源于其对不同患者亚群的重要性不同。因此，我们研究了患者和就诊特征之间的联系，以及患者重视护理连续性(PVC)的程度。我们假设，对于年龄较大、病情较重和女性、与医生建立了关系、就诊涉及更复杂问题的患者来说，连续性更重要。方法：一项对138名社区家庭医生的4454名连续门诊患者进行的研究使用了PVC的3项测量(α=0.67)。患者对(1)就诊的初级保健的充分性和(2)对医生就诊的满意度的报告采用多种测量方法进行评估。结果：极端的年龄、女性、受教育程度、医疗保险和医疗补助保险、慢性病和用药次数、就诊次数和较差的自我报告的健康状况与对连续性的更高重视程度相关(P<；.001，除性别外，P=.015)。重视连续性和没有看正规医生的患者对就诊充分性的评分(就诊的7个属性)低于看自己医生的患者。在看重连续性和定期看医生的患者中，对医生就诊的满意度最高。结论：医生护理的连续性与对就诊的更积极的评价有关，对于更脆弱的患者尤其重要。卫生保健系统和初级保健实践应该投入更多的努力来维持与这些脆弱患者的连续性关系。
BACKGROUND: Inconsistent findings on the value of continuity of care can stem from variability in its importance to different subsets of patients. We therefore examined the association among patient and visit characteristics and extent to which the patient valued continuity of care (PVC). We hypothesized that continuity would be more important to patients who are older, sicker, and female, who have established a relationship with their physician, and whose visit addresses more complex problems.METHODS: A study of 4,454 consecutive outpatient visits to 138 community-based family physicians used a 3-item measure (alpha = 0.67) of PVC. The patient's report of (1) the adequacy of primary care for the visit and (2) satisfaction with the physician on that visit was assessed with multiple measures. Analyses examined the associations among PVC and patient-reported satisfaction with the physician and adequacy of the visit.RESULTS: Extremes of age, female sex, less education, Medicare and Medicaid insurance, number of chronic conditions and medications, number of visits to the practice, and worse self-reported health status were associated with higher value placed on continuity (P < .001 for all except sex, where P = .015). Patients who value continuity and did not see a regular physician rated adequacy of the visit lower (for 7 attributes of the visit) than those seeing their own physician. Satisfaction with the physician for the visit was greatest among patients who value continuity and saw their regular physician.CONCLUSIONS: Continuity of physician care is associated with more positive assessments of the visit and appears to be particularly important for more vulnerable patients. Health care systems and primary care practices should devote additional effort to maintaining a continuity relationship with these vulnerable patients.