門番の難問を解決する:患者さんがプライマリケアで評価するものと,専門医への紹介
K Grumbach1, J V Selby, C Damberg
1Department of Family and Community Medicine, Primary Care Research Center, University of California, San Francisco, USA. keving@itsa.ucsf.edu
JAMA
|July 28, 1999
まとめ
患者は,初等医療従事者 (PCP) を,ファーストコンタクト・プロバイダーおよび紹介コーディネーターとして高く評価しています. しかし,専門家のアクセスを制限するゲートキーパー政策は,患者のPCPに対する信頼を損なう.
科学分野:
- 保健医療政策について
- プライマリーケア医療 プライマリーケア医療
- 患者の満足度について
背景:
- 管理ケアにおけるプライマリケア医師 (PCP) のゲートキーパーとしての役割に関する患者の視点に関するデータは限られている.
- 患者の見解を理解することは,医療の提供と管理ケアシステムの最適化に不可欠です.
研究 の 目的:
- ファーストコンタクト・プロバイダーおよび紹介コーディネーターとしてのPCPの患者評価を評価する.
- 患者がPCPを専門家のアクセスへの障壁として認識しているかどうかを判断する.
- 紹介アクセス問題とPCPに対する患者の信頼の関連性を調べる.
主な方法:
- カリフォルニア州の7718人の成人のマネージドケアメンバーを対象に1997年に横断調査が行われました.
- アンケートでは,PCPの役割に対する患者の態度,医師の評価 (信頼,自信,満足度),および推薦の障壁として認識されたものを評価しました.
- 統計分析では,患者と医師の評価の予測要因として,紹介障壁を調査した.
主要な成果:
- 患者の90%以上は,PCPをファーストコンタクトと紹介の調整に評価しました.
- 75%~91%は,専門医よりもPCPによる初期ケアを好む.
- 23%がPCPが専門家のアクセスを妨げていると報告した.
- 推薦を得ることの難しさは,より低い信頼 (OR 2.7),自信 (OR 2.2) および満足度 (OR 3.3) と相関しています.
結論:
- 患者は,医療の管理におけるPCPの統合された役割を高く評価しています.
- 専門家のアクセスを制限する管理ケア・ゲートキーパー政策は,PCPに対する患者の信頼と信頼に悪影響を及ぼします.
- 管理ケア政策を患者の好みと再調整することで,PCP-PCの関係を強化することができる.
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