{"title":"更好的在一起吗?法国全科医生多专业群体执业绩效的中介分析","authors":"Anna Zaytseva, Pierre Verger, Bruno Ventelou","doi":"10.1177/11786329251331128","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.</p><p><strong>Objectives: </strong>To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).</p><p><strong>Methods: </strong>We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.</p><p><strong>Results: </strong>In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.</p><p><strong>Conclusion: </strong>Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.</p><p><strong>Jel classification: </strong>I14, I18.</p>","PeriodicalId":12876,"journal":{"name":"Health Services Insights","volume":"18 ","pages":"11786329251331128"},"PeriodicalIF":2.4000,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056331/pdf/","citationCount":"0","resultStr":"{\"title\":\"Better Together? A Mediation Analysis of French General Practitioners' Performance in Multi Professional Group Practice.\",\"authors\":\"Anna Zaytseva, Pierre Verger, Bruno Ventelou\",\"doi\":\"10.1177/11786329251331128\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.</p><p><strong>Objectives: </strong>To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).</p><p><strong>Methods: </strong>We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.</p><p><strong>Results: </strong>In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.</p><p><strong>Conclusion: </strong>Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.</p><p><strong>Jel classification: </strong>I14, I18.</p>\",\"PeriodicalId\":12876,\"journal\":{\"name\":\"Health Services Insights\",\"volume\":\"18 \",\"pages\":\"11786329251331128\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-05-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056331/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Health Services Insights\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1177/11786329251331128\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q2\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Health Services Insights","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/11786329251331128","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Better Together? A Mediation Analysis of French General Practitioners' Performance in Multi Professional Group Practice.
Background: Integrated primary care teams remain a debatable policy in family medicine that could be a convenient response to French shortages in medical density.
Objectives: To analyse how general practitioners (GPs) respond to insufficient GP supply in their practice area in terms of quantity and quality of care, and how this response is mediated by enrolment in integrated primary care teams - multi-professional group practices (MGPs).
Methods: We used structural equation modelling on 3 representative cross-sectional surveys (2019-2020) of 1209 French GPs. Quantity and quality of care were approximated by latent variables comprising respectively GPs' demand absorption capacity and frequencies of vaccine recommendations.
Results: In the absence of potential mediators, low GP density was negatively associated with quantity (-0.221, unstandardized direct effects), but not with the quality of care. In the presence of mediators, low GP density was associated with higher work-related stress (0.120), which was consecutively associated with deteriorated demand absorption capacity (-0.202). Higher use of e-health tools was associated with greater involvement in vaccine recommendations (0.357). GPs in MGPs tended to use more e-health tools than those practicing outside MGPs (0.032), with a favourable effect on vaccine recommendations.
Conclusion: Lower level of work-related stress is the key mediator in handling patients' requests. When correcting for self-selection into MGPs, we found no significant mediation effect of enrolment in MGPs on the quantity of care but rather an effect on the quality of care. Our results pinpoint an added value of an enrolment in an MGPs to care quality that advocates for its further development.