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目的目前单人小型诊所面临的压力日渐增加,本研究旨在探讨参与单人小型诊所的家庭医生比例和该类诊所的特点、服务内容。方法 2013年,共10 888名美国家庭医学委员会认证的家庭医生参与了人口统计学调查。根据开展规模,可将诊所分为单人诊所、小型诊所(2~5人)、中型诊所(6~20人)及大型诊所(>20人)4类。对诊所医生所在郡县的乡村性进行评估,并采用Logistic回归模型分析单人或小型诊所的行医预测因子和单人诊所的行医预测因子。结果调查的家庭医生有一半以上在单人或小型诊所行医。其中,小型诊所的比例最大(36%),且多在农村地区(20%)。聘请护理协调员和医疗之家认证的可能性随着诊所规模的增加而增大。与中型或大型诊所相比,美籍非洲裔或西班牙裔医生进行小型或单人诊所的可能性较大,通常有30年以上的行医经验且多在乡村地区工作。与单人诊所相比,乡村性较高的家庭医生更倾向于选择小型诊所行医。结论在单人小型诊所行医的家庭医生中,大多数希望获得委员会认证,并更倾向于在乡村地区工作。扩展项目和社区卫生团队可以对单人小型诊所的转型提供帮助。
Objective The current pressure on single small clinics is increasing. The purpose of this study is to explore the proportion of family doctors involved in single small clinics and the characteristics and services of such clinics. Methods In 2013, a total of 10 888 American Family Medicine Commission accredited family doctors participated in the demographic survey. Depending on the scale, clinics can be divided into four categories: single clinics, small clinics (2 to 5), medium clinics (6 to 20) and large clinics (> 20). The rural nature of the clinic where the clinic is located was assessed and Logistic regression models were used to analyze the predictor of practice in single or small clinics and the predictor of practice in single clinics. As a result, more than half of GPs surveyed practiced in single or small clinics. Among them, the largest proportion of small clinics (36%), and more in rural areas (20%). The possibility of hiring a care coordinator and medical home certification increases with the size of the clinic. African-American or Hispanic-American doctors are more likely to have small or single clinics than medium- or large-sized clinics, often with more than 30 years of experience practicing medicine and working in rural areas. Compared with single clinics, family doctors with higher rural features are more inclined to choose small clinics for practicing medicine. Conclusion Most of the GPs practicing in a single-person clinic wished to be accredited by the Commission and preferred to work in rural areas. Expansion projects and community health teams can help transform the single-small clinics.