Abstract：
BACKGROUND: In the context of an ageing population and increasing health needs, primary care reform is needed and several new models have emerged, including the introduction of case managers in general practitioner practices.
OBJECTIVE: To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency.
METHODS: A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question \"Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?\", with possible answers \"Yes, within the practice\", \"Yes, outside the practice\", \"Yes, both within and outside the practice\" or \"No\". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed.
RESULTS: The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners.
CONCLUSIONS: The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.
OBJECTIVE: To describe the frequency of case managers in general practices in eleven Western countries between 2012 and 2019 and to investigate the characteristics of general practitioners and their practices associated with case manager frequency.
METHODS: A secondary analysis of the Commonwealth Fund International Health Policy Surveys of Primary Care Physicians, which were international cross-sectional studies conducted in 2012, 2015 and 2019. Random samples of general practitioners were selected in 11 Western countries (2012: n = 9776; 2015: n = 12,049; 2019: n = 13,200). The use of case managers in general practitioner practices was determined with the question \"Does your practice use personnel, such as nurses or case managers, to monitor and manage care for patients with chronic conditions that need regular follow-up care?\", with possible answers \"Yes, within the practice\", \"Yes, outside the practice\", \"Yes, both within and outside the practice\" or \"No\". Other variables characterising general practitioners and their practices were considered. Mixed-effects logistic regression was performed.
RESULTS: The frequency of case managers within general practitioner practices varied greatly by country, with an overall trend towards an increase from 2012 to 2019. In the multivariate analysis, more case managers were found in practices located in small towns (odds ratio [OR] 1.4; 95% confidence interval [CI] 1.2-1.7) and in rural areas (OR 1.9; 95% CI 1.5-2.4) compared to cities. The frequency of case managers was higher in larger practices, as shown in comparisons of practices in the second, third and fourth quartile of full-time equivalent employee counts compared to those in the first quartile (Q2: OR 1.7, 95% CI 1.4-1.9; Q3: OR 2.1, 95% CI 1.6-2.9; Q4: OR 3.8, 95% CI 3.0-4.9). There was no significant difference in frequency with respect to the age and sex of the general practitioners.
CONCLUSIONS: The use of case managers in general practitioner practices is a promising approach, but its practice varies greatly. This practice has been developing in Western countries and is tending to increase. The implementation of case managers seems to be associated with certain characteristics linked to general practitioner practices (practice location, practice size), whereas it does not seem to depend on the personal characteristics of general practitioners, such as age or sex.
摘要：
背景：在人口老龄化和健康需求增加的背景下，需要进行初级保健改革，并且出现了几种新的模式，包括在全科医生实践中引入案例经理。
目的：描述2012年至2019年11个西方国家的一般实践中病例经理的频率，并调查全科医生的特征及其与病例经理频率相关的实践。
方法：对英联邦基金国际初级保健医师卫生政策调查的二次分析，这是2012年、2015年和2019年进行的国际横断面研究。随机抽取11个西方国家的全科医生样本(2012年：n=9776；2015年：n=12,049；2019年：n=13,200)。在全科医生实践中使用案例经理的问题是：“您的实践使用人员，如护士或病例经理，监测和管理需要定期随访护理的慢性病患者的护理？“，可能的答案\“是的，在实践中，“，\"是的,在实践之外，“，\"是的,在实践之内和之外\"或\"No\"。考虑了其他表征全科医生及其实践的变量。进行混合效应逻辑回归。
结果：全科医生实践中病例经理的频率因国家而异，2012年至2019年总体呈增长趋势。在多变量分析中，与城市相比,在小城镇(比值比[OR]1.4;95%置信区间[CI]1.2-1.7)和农村地区(OR1.9;95%CI1.5-2.4)的实践中发现更多病例管理者.在更大的实践中，案件经理的频率更高，如第二部分的实践比较所示，与第一四分位数相比，第三和第四四分位数的全职同等雇员人数（Q2：OR1.7，95％CI1.4-1.9；Q3：OR2.1，95％CI1.6-2.9；Q4：OR3.8，95％CI3.0-4.9）。全科医生的年龄和性别在频率上没有显着差异。
结论：在全科医生实践中使用病例经理是一种有前途的方法，但是它的做法差异很大。这种做法在西方国家一直在发展，并有增加的趋势。病例经理的实施似乎与与全科医生实践（实践地点，练习尺寸)，虽然这似乎并不取决于全科医生的个人特征，比如年龄或性别。
目的：描述2012年至2019年11个西方国家的一般实践中病例经理的频率，并调查全科医生的特征及其与病例经理频率相关的实践。
方法：对英联邦基金国际初级保健医师卫生政策调查的二次分析，这是2012年、2015年和2019年进行的国际横断面研究。随机抽取11个西方国家的全科医生样本(2012年：n=9776；2015年：n=12,049；2019年：n=13,200)。在全科医生实践中使用案例经理的问题是：“您的实践使用人员，如护士或病例经理，监测和管理需要定期随访护理的慢性病患者的护理？“，可能的答案\“是的，在实践中，“，\"是的,在实践之外，“，\"是的,在实践之内和之外\"或\"No\"。考虑了其他表征全科医生及其实践的变量。进行混合效应逻辑回归。
结果：全科医生实践中病例经理的频率因国家而异，2012年至2019年总体呈增长趋势。在多变量分析中，与城市相比,在小城镇(比值比[OR]1.4;95%置信区间[CI]1.2-1.7)和农村地区(OR1.9;95%CI1.5-2.4)的实践中发现更多病例管理者.在更大的实践中，案件经理的频率更高，如第二部分的实践比较所示，与第一四分位数相比，第三和第四四分位数的全职同等雇员人数（Q2：OR1.7，95％CI1.4-1.9；Q3：OR2.1，95％CI1.6-2.9；Q4：OR3.8，95％CI3.0-4.9）。全科医生的年龄和性别在频率上没有显着差异。
结论：在全科医生实践中使用病例经理是一种有前途的方法，但是它的做法差异很大。这种做法在西方国家一直在发展，并有增加的趋势。病例经理的实施似乎与与全科医生实践（实践地点，练习尺寸)，虽然这似乎并不取决于全科医生的个人特征，比如年龄或性别。
