How general practitioners in France are coping with increased healthcare demand and physician shortages. A panel data survey and hierarchical clustering

IF 3.6 3区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Health Policy Pub Date : 2024-09-29 DOI:10.1016/j.healthpol.2024.105175

Bérengère Davin-Casalena , Dimitri Scronias , Yann Videau , Pierre Verger

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引用次数: 0

Abstract

Background

General practitioners (GPs) face quantitative and qualitative changes in patient demand and doctor shortages.

Objectives

To investigate how GPs cope with doctor shortage issues.

Materials and methods

Two cross-sectional surveys of a representative panel of 1530 GPs in 2019 and 2022 about their perceptions of physician shortages, working hours worked (WHW), and adaptive behaviors. Hierarchical clustering enabled identification of profiles with different adaptation patterns. Multiple Poisson or logistic regression models studied associations between GPs’ profiles and professional characteristics.

Results

87.4 % of GPs applied at least one adaptation to control patients’ healthcare demand. 24 % adopted task-shifting while their average WHW decreased by 3.6 h between 2019 and 2022. Four GP profiles were identified. “Low adapters/low workload” and “Low adapters/high workload” (25 % of the sample each) reported 2.4 adaptive measures: 75.5 % refused to be new patients' preferred doctor in the former group (vs 5.1 %). “High adapters/unchanged consultations” (30.7 %) and “High adapters/shortened consultations” (18.9 %) reported 4.8 and 6.1 adaptations, respectively. They were more likely to practice in medically underserved areas.

Conclusion

These results call into question GPs’ gatekeeper role in the French healthcare system. Moreover, the marked reduction in WHW in underserved areas is likely to exacerbate their uneven distribution nationwide. Encouraging vertical integration between HCPs while enhancing cooperation and task-shifting is probably a pathway toward improving the relative GP shortage.

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法国全科医生如何应对日益增长的医疗需求和医生短缺问题。面板数据调查与分层聚类。

背景：全科医生（GP全科医生（GPs）面临着患者需求和医生短缺的量变和质变：调查全科医生如何应对医生短缺问题：分别于 2019 年和 2022 年对 1530 名全科医生进行了两次横向调查，了解他们对医生短缺、工作时间（WHW）和适应行为的看法。通过层次聚类，确定了具有不同适应模式的特征。多重泊松或逻辑回归模型研究了全科医生的情况与专业特征之间的关联：87.4%的全科医生至少采用了一种适应方式来控制患者的医疗需求。24%的全科医生采用了任务转移，而在2019年至2022年期间，他们的平均全科医生工作时间减少了3.6小时。研究发现了四种全科医生的情况。"低适应性/低工作量 "和 "低适应性/高工作量"（各占样本的 25%）报告了 2.4 项适应性措施：在前一组中，75.5% 的人拒绝成为新患者的首选医生（对比 5.1%）。"高度适应/改变诊疗"（30.7%）和 "高度适应/缩短诊疗"（18.9%）分别报告了 4.8 和 6.1 项适应措施。他们更有可能在医疗服务不足的地区执业：这些结果使人们对全科医生在法国医疗系统中的守门人角色产生了质疑。此外，医疗服务欠缺地区的全科医生人数明显减少，这可能会加剧全科医生在全国范围内的分布不均。鼓励医疗保健人员之间的纵向整合，同时加强合作和任务分工，可能是改善全科医生相对短缺的一条途径。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Policy 医学-卫生保健

CiteScore

6.40

自引率

6.10%

发文量

157

审稿时长

3-8 weeks

期刊介绍： Health Policy is intended to be a vehicle for the exploration and discussion of health policy and health system issues and is aimed in particular at enhancing communication between health policy and system researchers, legislators, decision-makers and professionals concerned with developing, implementing, and analysing health policy, health systems and health care reforms, primarily in high-income countries outside the U.S.A.