Home visiting by general practitioners in England and Wales
Home visiting by general practitioners in England and Wales
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DOI：
10.1136/bmj.313.7051.207
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发表时间：
1996-07-27
影响因子：
--
通讯作者：
Cook, DG
中科院分区：
文献类型：
--
作者：
Aylin, P;Majeed, FA;Cook, DG
目的：利用第四次全国全科医生患病率调查数据，探讨全科医生家访率与患者特征之间的关系。设计-调查全科医生所有家访的诊断性数据。设置英格兰和威尔士的60个全科医生。研究对象：1991年9月至1992年8月期间，502 493名患者在家中就诊。主要观察指标--每1000个患者年的家访率和按年龄和性别标准化的家访率。结果与全科医生接触的10.1%(139 801/1 378 510)发生在患者家中。年平均家访率为299/1000病人年。发病率与年龄呈J型关系，16-24岁最低(103/1000)，大于或等于85岁(3009/1000)最高。1.3%的患者就诊次数在5次以上，39%的患者就诊次数达到39%。年龄和性别标准化家访比率从社会阶层I的69人(95%可信区间68~70)增加到社会阶层V的129人(128~130)。最常见的诊断群体是呼吸系统疾病。在年龄较大的人群中，循环系统疾病也是常见的诊断组。这项研究中60个实践的标准化家访比率变化了近8倍，从28到218(四分位数从67到126)。结论-家访仍然是全科医生工作量的重要组成部分。除了家访率和患者特征之间的强烈关联外，在家访率方面的做法也存在很大差异。少数患者接受了不成比例的高家访次数。对家访率高的患者的进一步调查可能有助于解释一般做法之间工作量的巨大差异，并有助于为做法分配资源。
Objective-To use data from the fourth national survey of morbidity in general practice to investigate the association between home visiting rates and patients' characteristics.Design-Survey of diagnostic data on all home visits by general practitioners.Setting-60 general practices in England and Wales.Subjects-502 493 patients visited at home between September 1991 and August 1992.Main outcome measures-Home visiting rates per 1000 patient years and home visiting ratios standardised for age and sex.Results-10.1% (139 801/1 378 510) of contacts with general practitioners took place in patients' homes. The average annual home visiting rate was 299/1000 patient years. Rates showed a J shaped relation with age and were lowest in people aged 16-24 years (103/1000) and highest in people aged greater than or equal to 85 years (3009/1000). 1.3% of patients were visited five or more times and received 39% of visits. Age and sex standardised home visiting ratios increased from 69 (95% confidence interval 68 to 70) in social class I to 129 (128 to 130) in social class V. The commonest diagnostic group was diseases of the respiratory system. In older age groups, diseases of the circulatory system was also a common diagnostic group. Standardised home visiting ratios for the 60 practices in the study varied nearly eightfold, from 28 to 218 (interquartile range 67 to 126).Conclusions-Home visits remain an important component of general practitioners' workload. As well as the strong associations between home visiting rates and patient characteristics, there were also large differences between practices in home visiting rates. A small number of patients received a disproportionately high number of home visits. Further investigation of patients with high home visiting rates may help to explain the large differences in workload between general practices and help in allocation of resources to practices.