It's official: family doctors are good for your health
http://www.100md.com
《英国医生杂志》
Contrary to a widespread belief that doctors do more harm than good—borne out by declines in mortality during doctors?strikes—a new study shows that doctors actually do save lives. Its results show that one additional primary care doctor in an area can lower mortality in that area by around 2%.
The authors, from Johns Hopkins University, Baltimore, the US Department of Health and Human Services at Bethesda, Maryland, and New York University, say that their results indicate that increasing resources for primary care may be one way to help offset the effects of disadvantage on health and that primary care can help reduce socioeconomic disparities.
The research showed that across the United States mortality fell by 14.4 deaths per 100 000 people during an 11 year period when the number of primary care doctors increased by one for every 10 000 people (Social Science & Medicine 2005;61:65-75).
"The study provides evidence that primary care resources are associated with population health and could aid in reducing socioeconomic disparities," the report says.
In the study the authors used 11 years of state data to examine the relations between primary care resources, income inequality, and mortality. They analysed trends in mortality, income inequality, ratios of primary care provision to population size, and sociodemographic characteristics.
Over this period all cause mortality declined. The mean state mortality, adjusted for age, dropped from 821 to 762 per 100 000 people. Also, the number of primary care doctors increased steadily, from 5.02 to 6.04 per 10 000 people. At the same time inequality in incomes grew overall.
When the authors controlled for income inequality and demographic characteristics they found an independent association between primary care provision and mortality. The report says, "An increase of one primary care doctor is independently associated, on average, with a reduction of 14.4 deaths, per 100,000 population—about a 2% decline over current levels."
They also found that the association between primary care and mortality was 2.5 times greater in black people than in white people.
"These findings are significant because they provide more robust evidence of a relationship between primary care physicians and lower state mortality than was possible by previous cross-sectional analyses," says the report.
"According to the results of this study, primary care is associated with improvements in health reductions in mortality over time while other risk factors (e.g. unemployment, education) are positively associated with eroding health status over time."
The researchers say that there is evidence that high quality primary care can lead to more efficient secondary and tertiary care: "We hypothesise that the unique features of primary care, such as continuous, longitudinal, and person-focused care, may also work to reverse some of the negative health effects of social inequalities by short-circuiting the ability of long-term stressors to produce chronic ailments."
They add, "The promotion of primary care may serve as a more feasible and less expensive strategy for combating mortality and for reducing socioeconomic disparities in health, compared with either social policy that addresses sociodemographic determinants of health or behavioural modifications. Such a hypothesis at least deserves consideration in the face of declining health levels of the US relative to comparably industrialised nations."(Abergavenny Roger Dobson)
The authors, from Johns Hopkins University, Baltimore, the US Department of Health and Human Services at Bethesda, Maryland, and New York University, say that their results indicate that increasing resources for primary care may be one way to help offset the effects of disadvantage on health and that primary care can help reduce socioeconomic disparities.
The research showed that across the United States mortality fell by 14.4 deaths per 100 000 people during an 11 year period when the number of primary care doctors increased by one for every 10 000 people (Social Science & Medicine 2005;61:65-75).
"The study provides evidence that primary care resources are associated with population health and could aid in reducing socioeconomic disparities," the report says.
In the study the authors used 11 years of state data to examine the relations between primary care resources, income inequality, and mortality. They analysed trends in mortality, income inequality, ratios of primary care provision to population size, and sociodemographic characteristics.
Over this period all cause mortality declined. The mean state mortality, adjusted for age, dropped from 821 to 762 per 100 000 people. Also, the number of primary care doctors increased steadily, from 5.02 to 6.04 per 10 000 people. At the same time inequality in incomes grew overall.
When the authors controlled for income inequality and demographic characteristics they found an independent association between primary care provision and mortality. The report says, "An increase of one primary care doctor is independently associated, on average, with a reduction of 14.4 deaths, per 100,000 population—about a 2% decline over current levels."
They also found that the association between primary care and mortality was 2.5 times greater in black people than in white people.
"These findings are significant because they provide more robust evidence of a relationship between primary care physicians and lower state mortality than was possible by previous cross-sectional analyses," says the report.
"According to the results of this study, primary care is associated with improvements in health reductions in mortality over time while other risk factors (e.g. unemployment, education) are positively associated with eroding health status over time."
The researchers say that there is evidence that high quality primary care can lead to more efficient secondary and tertiary care: "We hypothesise that the unique features of primary care, such as continuous, longitudinal, and person-focused care, may also work to reverse some of the negative health effects of social inequalities by short-circuiting the ability of long-term stressors to produce chronic ailments."
They add, "The promotion of primary care may serve as a more feasible and less expensive strategy for combating mortality and for reducing socioeconomic disparities in health, compared with either social policy that addresses sociodemographic determinants of health or behavioural modifications. Such a hypothesis at least deserves consideration in the face of declining health levels of the US relative to comparably industrialised nations."(Abergavenny Roger Dobson)