従
来、プライマリケア医が行っていた日常的かつ予防的治療を、専門医が行う頻度が増えていることが、新しい研究によって明らかにされた。医師自身の報告に基
づく、全米でサンプル抽出された2万5,000件以上の外来受診において、専門医受診の約半数が日常的治療や予防的な治療を目的としていたという。米 医学誌「Annals of Family Medicine（家庭医学）」3/4月号に掲載された研究で、英マンチェスター大学のJose M. Valderas博士らは、麻酔学専門医、病理医、放射線医を除く、内科、外科、産科婦人科、精神科など多数の専門医のデータを検討した。
全 米外来医療調査（NAMCS）における2年間の外来受診のデータをレビューした結果、専門医受診患者の46％はすでにその専門医の診察を受けており、ルー チンの経過観察や予防的な治療のために再度受診していることが判明した。紹介受診は3分の1以下で、専門医を受診した患者の4分の3は同じ医師を再受診し ていた。
米セントジョン・マコームオークランドSt. John Macomb-Oakland病院（ミシガン州）のSam Awada博士は「問題は、専門医が一次医療の標準的な治療法を知っているとは限らないことである。家庭医と専門医間で容易に連携が可能となる必要があ る」と指摘している。
米ニューヨーク大学ランゴンLangoneメディカルセンターのMarc Siegel博士は「米国の医療は専門化の方向に向かっているが、費用対効果が低いことは明らか。専門医が特に関与する必要のない治療はすべてプライマリ ケア医が行うことができ、また行うべきである」と述べている。
同誌に掲載されている別の研究では、家庭医による出産前の胎児検診も10年 前より減少していることが判明。出産前の家庭医受診は、10年間で約12％から6％強に減少し、都市部以外では約39％から13％とさらに大きく減少して いた。胎児検診で家庭医を受診する母親は、大都市部以外に居住し、メディケイド（低所得者に対する公的医療保障）の対象であり、若齢層（24歳未満）か年 齢が高い層（30歳以上）である傾向がみられた。（HealthDay News 3月10日）
http://www.healthday.com/Article.asp?AID=624894
2009年3月25日 10:17 [医療全般]
For Primary Care, More Patients Are
Seeing Specialists
Even prenatal care visits to family doctors are
declining, researchers find
By Serena Gordon
HealthDay Reporter
 TUESDAY, March 10 (HealthDay News) -- Specialists are increasingly providing routine and preventive services that have traditionally been handled by primary care doctors, a new study has found. "In a nationally representative sample of more than 25,000 visits [in the United States], we have observed that about half of all visits for specialized care is for routine and preventive care, as reported by physicians themselves," said study author, Dr. Jose M. Valderas, a clinical lecturer at the University of Manchester in the United Kingdom. The researchers looked at data on numerous specialties, including medical, surgical, obstetrics/gynecology and psychiatry. The only specialists specifically excluded from the study were anesthesiologists, pathologists and radiologists. After reviewing two years of data on office visits from the National Ambulatory Medical Care Survey, the researchers found that 46 percent of visits to specialists were made by people who had already been seen by the specialist and were returning for routine follow-up or preventive care. Just under a third of the visits resulted from a referral, and three-fourths of all visits to specialists resulted in a return appointment with the same physician. The findings were published in the March/April issue of theAnnals of Family Medicine. "The problem is that specialists don't necessarily know the standard of care" for primary care, explained Dr. Sam Awada, chief of family medicine at St. John Macomb-Oakland Hospital in Warren, Mich. "For example, I knew an oncologist who was taking care of a patient, and this lady got a foot problem. He gave her Motrin, but when it persisted, and she came to see me, I discovered she had a fracture, not a sprain. That's putting yourself in a quagmire unnecessarily. If I tried to manage someone's cardiac problem or their cancer, I'd be just as guilty. It should be an easy two-way street between family doctors and specialists." Dr. Marc Siegel, an internist at New York University Langone Medical Center in New York City, said that he "would argue that if a specialist sees you for primary prevention, you're more likely to end up having a procedure." "Although the nation is going in the direction of specialization, it's clearly not cost-effective," Siegel said. Valderas said that "all care that does not need the specific involvement of a specialist could potentially and should be done by primary care physicians." Looking at health-care systems worldwide, he said, "health systems oriented towards primary care have consistently demonstrated better or comparable outcomes at lower costs." Pregnant women appear to be among those seeing specialists more often for routine care. In the same issue of the journal, another study found that family physicians are less likely to offer prenatal care to their expectant patients today than they were a decade ago. It found that prenatal visits to family physicians declined from nearly 12 percent to just over 6 percent in a 10-year period. In non-urban areas, the drop was even more striking: from about 39 percent to 13 percent, the study found. Expectant mothers who did visit their family physician for prenatal care were more likely to live in a non-metropolitan area, to be on Medicaid, and to be either younger (under 24) or older (over 30). In rural areas, a lack of family physicians who don't offer prenatal care "could be a disaster," said Awada. Many family physician residency programs no longer focus on prenatal obstetrical care, he added. A third study in the journal suggests that the consequences could be more far-reaching than just prenatal care. It found that, along with getting prenatal care, nearly one in five prenatal visits with a family physician also covered a medical issue not related to obstetrics. More information Whether you're seeing a primary care doctor or a specialist, the Agency for Healthcare Research and Quality has advice onchoosing a doctor.
Last Updated: March 10, 2009 Copyright © 2009ScoutNews, LLC. All rights reserved. |
