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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Primary care physician supply and children's health care use, access, and outcomes: findings from Canada.
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Primary care physician supply and children's health care use, access, and outcomes: findings from Canada.

机译：初级保健医师的供应以及儿童保健的使用，获取和结果：加拿大的调查结果。

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OBJECTIVES: To describe the relationship of primary care physician (PCP) supply for children and measures of health care access, use, and outcomes. METHODS: We conducted a population-based, cross-sectional study of all Ontario children from 2003 to 2005. We used health administrative data to calculate county-level supply (full-time equivalents [FTEs]) of PCPs. We modeled the relationship of supply to (1) recommended primary care visits, (2) emergency department (ED) use, and (3) ambulatory care-sensitive condition admissions and adjusted for neighborhood income. We used population-based surveys to describe access. RESULTS: The county-level PCP supply ranged from 1720 to 4720 children per FTE. Of the children, 45.4% live in the highest-supply areas (<2000 children per FTE) and 8% in the lowest-supply areas (>3000 children per FTE). Compared with high-supply counties, the lowest had significantly lower rates of primary care visits (2716 vs 7490 per 1000) and higher proportions of newborns without early follow-care (58.2% vs 14.5%). Low-supply areas had higher rates of ED visits (440 vs 179 per 1000) and admissions. A stepwise gradient existed for every decrease in supply for most measures. Self-reported access barriers were most evident in areas with >3500 children per FTE (32.8% without a physician). CONCLUSIONS: Under universal insurance there are differences in access to, and outcomes of, primary care related to local physician supply after controlling for neighborhood income. The most pronounced effect is on primary and ED care use, but there are implications for acute and chronic disease control. Physician distribution is a critical issue to address in policies to improve access to care.
机译：目的：描述儿童的初级保健医师（PCP）供应的关系以及卫生保健的获取，使用和结果的度量。方法：我们对2003年至2005年所有安大略儿童进行了基于人口的横断面研究。我们使用卫生行政数据来计算县级PCP的供应量（全日制当量[FTE]）。我们对供应与（1）推荐的初级保健就诊，（2）急诊科（ED）的使用以及（3）对非卧床护理敏感的条件入院的关系进行了建模，并根据邻里收入进行了调整。我们使用基于人口的调查来描述访问。结果：每个FTE，县级PCP供应范围为1720至4720名儿童。在这些儿童中，有45.4％的人生活在供应最高的地区（每FTE少于2000名儿童），而有8％的人是生活水平最低的地区（每FTE超过3000名儿童）。与供应充足的县相比，最低的县的初级保健就诊率显着较低（每千人分别为2716比7490），而没有早期随访的新生儿比例更高（58.2％比14.5％）。供不应求的地区急诊就诊率和入院率较高（440比179/1000）。大多数措施中，每次供应减少都会存在一个逐步梯度。自我报告的通行障碍在每个FTE有3500名以上儿童的地区最为明显（无医生的情况为32.8％）。结论：在全民保险下，在控制了社区收入之后，与当地医生提供有关的初级保健的机会和结果存在差异。最明显的影响是对初级和急诊护理的使用，但对急性和慢性疾病控制有影响。医师分配是在政策中要解决的一个关键问题，以改善获得护理的机会。

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