论文部分内容阅读
目的良好的医患协作被证实为促进美国医疗保健系统有效、安全、高效运行的重要因素。本文旨在探讨美国及其他10个高收入国家中,人口或医疗保健系统相关因素对患者与全科医生间协作不良的影响。方法采用多因素Logistic回归分析对2013年英联邦基金会公众国际健康政策调查所得数据进行分析。研究对象为11个高收入国家(澳大利亚、加拿大、法国、德国、荷兰、新西兰、挪威、瑞典、瑞士、英国、美国)中接受社区卫生服务的成年患者。在患者与全科医生协作相关的5个事项中,有3项及以上不达标即被认定为协作不良。结果共13 958例患者接受了调查,其中5.2%(724/13 958)的患者认为与全科医生间存在协作不良,且美国[9.8%(137/1 395)]高于其他国家。多因素Logistic回归分析结果显示,全科医生经常/总是熟悉患者病史、能够花费足够时间为患者提供诊疗服务、能够与患者相互配合、能够清楚地向患者解释病情,是增强患者与全科医生间协作性的有利因素(OR值均为0.6)。慢性病患者(OR值为1.4~2.1,数值因患者例数而不同)、<65岁患者(OR值为1.6~2.3,数值因患者年龄而不同)与全科医生间协作不良的发生率较高。在美国患者中,参保状况、健康状况、家庭收入、性别和患者与全科医生间协作不良不相关。结论在调查的11个高收入国家中,美国的患者与全科医生间协作性最差。患者与全科医生间的友好关系与良好的就医协作密切相关,患慢性病和低龄是导致患者与全科医生间协作不良的危险因素。
Well-targeted collaboration between doctors and patients has been shown to be an important factor in the effective, safe and efficient operation of the U.S. healthcare system. The purpose of this article is to explore the impact of demographic or healthcare system-related factors on poor co-operation between patients and GPs in the United States and 10 other high-income countries. Methods The multivariate Logistic regression analysis was used to analyze data from the 2013 Commonwealth Foundation Public Health Survey. The study was conducted on adult patients receiving community health services from 11 high-income countries (Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, United Kingdom, United States). Three out of five of the five issues that patients collaborate with general practitioners were found to be poorly coordinated. Results A total of 13,958 patients were surveyed, with 5.2% (724/13 958) of patients considered poor co-ordination with general practitioners and the United States [9.8% (137/1 395)] higher than in other countries. Multivariate logistic regression analysis showed that general practitioners are often / always familiar with the patient’s medical history, able to spend sufficient time to provide services for patients, cooperate with the patients and clearly explain the condition to the patients, so as to enhance the relationship between the patients and general practitioners The favorable factors of inter-cooperation (OR value 0.6). Patients with chronic disease (odds ratio, 1.4-2.1, varying depending on the number of patients) had a higher prevalence of poor coping with general practitioners in patients <65 years (odds ratio, 1.6 to 2.3, with different values depending on patient age) . Among the U.S. patients, insured conditions, health status, household income, gender, and poor co-ordination between the patient and the GP are not relevant. Conclusions Among the 11 high-income countries surveyed, the United States had the worst collaboration among the general practitioners. The friendly relations between patients and general practitioners are closely related to good medical cooperation. Chronic diseases and young people are the risk factors for poor cooperation between patients and general practitioners.