综合性医院儿科门诊就诊者心理行为问题调查

目的了解综合性医院儿科门诊就诊患者中有关心理行为问题,以及家长们对待儿童心理问题的态度及诊治需求。方法对2006年12月至2007年1月在本院儿科门诊就诊的4~15岁儿童的家长或监护人进行问卷调查,采用自行设计问卷及儿科症状检查表(PSC),对结果进行统计学分析。结果39.2%的家长认为患躯体疾病会使儿童产生心理行为方面的影响,如睡眠不好、易激惹发脾气等。16.6%的家长认为孩子平时有心理行为方面的问题,然而其中只有39.4%的家长与医师讨论过这些问题,与此相比78.8%的家长能与自己的亲友讨论这些问题。如果发现孩子有心理行为问题,55.8%的家长选择在心理门诊就诊,32.2%的家长选择在儿保门诊就诊,8.5%的家长选择在普通儿科门诊就诊,3.5%的家长选择在精神科门诊就诊。结论患躯体疾病会对孩子产生一些心理行为方面的影响,儿科门诊医师在诊治儿童的躯体疾病时不应忽略这些影响,应予早期的处理,问题严重时转诊到精神专科。虽然家长已经发现孩子平时存在心理行为方面的问题,真正与医师讨论过的家长还不到一半,这影响了儿童心理行为方面的问题的解决。与在精神专科就诊相比,家长们更愿意在心理门诊及儿保门诊就诊,但选择在普通儿科门诊就诊的家长不多,应该充分利用普通儿科门诊这个解决儿童心理行为问题的最便利的资源,改善我国儿童的精神健康服务。     

Women in pediatrics: the experience in Quebec.

OBJECTIVES: To compare the practice patterns of female pediatricians in Quebec with those of their male counterparts and to identify specific factors influencing these practice patterns. DESIGN: Matched cohort questionnaire survey. SETTING: Primary, secondary and tertiary care pediatric practices in Quebec. PARTICIPANTS: All 146 female pediatricians and 133 of the 298 male pediatricians, matched for age as well as type and site of practice; 119 (82%) of the female and 115 (86%) of the male pediatricians responded. MAIN OUTCOME MEASURES: Demographic and family data as well as detailed information about the practice profile. RESULTS: The two groups were comparable regarding demographic data, professional work and patient care. Compared with the male respondents, the female pediatricians were younger and saw more outpatients. The mean number of hours worked per week, excluding on-call duty, was 40.5 (standard deviation [SD] 12.4) for the women and 48.9 (SD 12.0) for the men (p < 0.001). The female pediatricians were more likely than their male counterparts to have spouses who were also physicians (40%) or in another profession (45%). The female pediatricians without children worked significantly fewer hours than the male pediatricians with or without children (p < 0.001). Children (p = 0.006), but not the number of children (p = 0.452), had a significant effect on the number of hours worked by the female pediatricians. CONCLUSION: The duality of the role of female physicians as mothers and professional caregivers must be considered during workload evaluations. If the same style of practice and the increase in the proportion of female pediatricians continue, about 20% more pediatricians will be needed in 10 years to accomplish the same workload.     

Walk-in clinics: implications for family practice.

To understand better the reasons for the growth in popularity of walk-in clinics in Canada we surveyed 321 patients with a regular physician in Toronto who attended a walk-in clinic in the same city over a 16-day period in February 1988. They were asked their reason for attending the clinic, their perception of the urgency of their problem, their choices as alternatives to walk-in clinics and their satisfaction and concerns with the type of care received at the clinic. The three most common reasons for attending the clinic were convenient location (in 33% of the cases), inability to see their regular physician soon enough (in 16%) and no appointment needed (in 13%). Most (80%) of the patients felt that they needed medical attention within 24 hours after the onset of their problem. Most (83%) of the respondents would have sought medical attention at another walk-in clinic, from their regular physician or at an emergency department had the clinic been closed. Only 36% and 18% of the patients respectively responded that their regular physician worked evenings or weekends. Most of the visits to the clinic were outside regular weekday business hours. The level of satisfaction with the service received at the clinic was high. The extended hours and no-appointment philosophy of walk-in clinics, coupled with family physicians' reluctance to work evenings and weekends, have made such clinics an attractive option for patients with primary care problems that they believe require prompt attention.     

Attitude of the parents seeking service from the paediatricians

The overuse of antibiotics and other medicines have been standing a dangerous proposition and researchers are coming in fore front analyzing and assessing the aftermath of years of misperceptions and inappropriate usage of drugs prescribed by the pediatricians. Two hundred and two parents from the community as well as from the outpatient department of medical college hospitals were interviewed, to study their attitude while seeking for the health service for their children. Data were collected through a face-to-face interview using a structured questionnaire. One hundred and ninety nine (82.7%) of the parents interviewed were mothers and only 3 (1.5%) were fathers. One hundred and sixty-seven (82.7%) parents were from the urban population and the rest 35 (17.3%) were from rural areas. The mothers mean stay in the educational institution was 11.8 years and that of the father's was 13.1 years. About 34.7% parents had to seek for doctor's advice at least once or twice a month and around 43% had to visit doctor's clinic. Most (66.8%) of the parents were from the family earning tk.6000 to tk.20000 a month, 19.8% and 13.4 % were from the families earning below tk.6000 and above tk.20000 respectively. A vast majority of the parents expressed their preference for advice to medicines. Among the medicines they like antibiotics more than vitamins. Majority of the parents showed their interest to spend more time and to have less medicine. For anorexic children parents preferred advice to medicines. An overwhelming majority (98%) of the parents was interested to get advice and ORS for diarrhea. For ARI also a larger number (56.1%) of parents opted for advice only and no medicine at all but 37.1% kept their option for both. A large majority of the parents were preferring more frequent visit and having fewer medicines than the conditions of more medicines with less frequented visits.     

Knowledge and attitudes about smoking and environmental tobacco smoke: a comparison of parents and children attending upper and lower income pediatric sites

To define differences in knowledge and attitudes about environmental tobacco smoke (ETS) and smoking among different populations of parents and children, surveys about smoking and health were administered in low-income pediatric clinics and upper-income private practices using a Likert scale. Sixty-five children and 300 parents from pediatric clinics and 149 children and 300 parents from private practices participated. At the clinics 39% of parents were white, 23% graduated college, 33% smoked, and 20% allowed smoking in their home. This differed from private practices where 93% of parents were white, 77% graduated college, 13% smoked and 6% allowed smoking in their home. Parents from private practices expressed greater agreement with fact and opinion statements about ill effects of tobacco. More lower income children reported living with a smoker (45% vs 23%). These data demonstrate differences in adult knowledge and attitudes about health effects of smoking, highlighting the need for increased intervention among lower income families.     

武汉市0-5岁儿童参加医疗保险影响因素研究

目的:了解武汉市0-5岁儿童医疗保险待遇现状以及参加医疗保险影响因素,为进一步完善武汉市儿童医疗保障制度提供理论依据和政策建议。方法:资料来源于320份5岁以下儿童家庭问卷,用SPSS12.0进行统计分析。结果:38.4%的儿童没有任何的医疗保险,22.2%的儿童家长外出务工,90.0%的母亲具有较高文化水平,家庭年均收入为4.73万元。结论:对政策不了解、父母外出务工、母亲文化程度及收入情况影响儿童参加医疗保险。建议:加强政策宣传,积极引导儿童参加医疗保险;关注低收入家庭儿童;为流动儿童参加医保建立畅通的渠道。     

A survey of Papua New Guinean private medical practitioners

A postal survey of all Papua New Guinean private medical practitioners was conducted to ascertain their practice characteristics, how well they kept up with current medical knowledge and whether they were interested in contributing to public sector medicine. Replies were received from 44% of the doctors, who mostly represented the younger age group of graduates. The majority of the responders had entered private practice since 1981, were self-employed and made little use of existing opportunities for keeping up to date with medical knowledge. The average number of patients seen in a day showed a normal distribution with a peak at 20-29 patients per day. Over 75% of the responders stated that they would be willing to work for the government health services on a sessional basis at an average minimum hourly rate of K40. Financial reasons were given as the main justification for leaving government service. When asked whether they would return to full-time public service if doctors' terms and conditions improved, the private practitioners were evenly divided. Those interested in returning would expect an average annual salary of approximately K30,000 per annum. In this paper we argue that private medical care has so far been allowed to develop without guidance and controls, and little use has been made of it to support government health services. Escalating shortages of financial and human resources have now made it imperative to find innovative ways of developing both services in harmony with each other so that private medical services for the mostly urban minority will not grow to the detriment of public medical services for the rural majority.     

Head injuries related to the use of baby walkers.

To determine what proportion of head injuries in children under 24 months of age who presented to an emergency department were related to the use of baby walkers, we reviewed the charts of 52 such children. Walkers were involved in 42% of the head injuries in the children under 12 months of age and in none of those in the children aged 12 to 24 months. All walker-related injuries, including skull fractures in three children, involved stairs (p less than 0.001). Questionnaires were also sent to all families with children aged 3 to 18 months attending a private pediatric practice to determine the prevalence of falls involving baby walkers among these children and the factors associated with such falls. Of the 152 responding families 82% reported using or having used a walker. Thirty-six percent of the families reported that their child had a fall while in a walker, with 8.8% of the falls resulting in contact with a doctor. Walker-related falls were directly associated with time spent in the walker (p less than 0.001) and with a previous fall from the walker by an older sibling (p less than 0.03). Since there is no demonstrated benefit of walkers, their use should not be encouraged, and parents should be advised of their potential danger.     

Barriers to measles immunization: the beliefs and attitudes of caregivers in Goroka, Eastern Highlands Province, Papua New Guinea

In Papua New Guinea, measles remains a public health problem and the majority of measles cases occur in non-immunized children. In Goroka, measles vaccine coverage for the 9-month-old group was 44%. The parents or caregivers are important in measles prevention as children's immunization depends on their compliance. This study aimed to determine the factors that hinder caregivers from having their children vaccinated for measles prevention in the Goroka District, Eastern Highlands Province. A cross-sectional study was conducted in July-August 2003, using pre-constructed questionnaires and interviews. There was a total of 120 respondents who were caregivers or parents of children whose ages ranged from 6 to 12 months and who attended health care centres where immunization services were provided. The main reasons for not bringing their children to clinic for immunization were: limited access to health centres, especially to maternal and child health (MCH) clinics; too long a waiting time at the clinic; concern that too many injections were being given to their children; the side-effects of the vaccine; being sent away and asked to come back the next day for immunization; and a bad reception from health workers. Funerals or election-related events in the area also affected the attendance at the clinic. In order to improve the vaccine coverage, the use of a mobile MCH clinic should be re-established. Health workers should utilize the opportunities to pass on necessary information on immunization to caregivers, as well as being mindful to use communication that will prevent misunderstanding by the mothers. It is important for all health workers to recognize that their performance and attitude can greatly improve the overall vaccine coverage in Papua New Guinea.     

Frequent users of ambulatory health care in Quebec: the case of doctor-shoppers.

OBJECTIVE: To examine the patterns of use of ambulatory care in Quebec in 1991, with special emphasis on patients who received care from more than 20 physicians. DESIGN: Retrospective study of population-based data. SETTING: Province of Quebec. PARTICIPANTS: All 7,154,591 people eligible for coverage under the Régie de l'assurance-maladie du Québec (RAMQ) (Quebec Health Insurance Plan) in 1991, including 3639 people who received ambulatory care from more than 20 physicians. DATA EXTRACTION: The databanks of the RAMQ. OUTCOME MEASURES: Mean number (and standard deviation) of physician visits and services received, place of visit (clinic or private office), mean cost of services, patient's age, diagnosis, type of specialist visited and social assistance status of frequent users. RESULTS: The patients who obtained ambulatory care from more than 20 physicians received 10 times more medical services than the overall patient population (59.6 v. 5.8), and the mean cost per patient for ambulatory care was also 10 times higher ($1379 v. $136). Almost all of the frequent users visited at least one outpatient clinic, as compared with 37.3% of the overall population. A higher proportion of the frequent users than of the overall population obtained care from specialists (98.9% v. 54.7%), mainly general surgeons and psychiatrists. The most frequent diagnoses among the frequent users were anxiety (36.0%), abdominal pain (24.3%), drug or alcohol dependence (22.2%) and depression (16.4%). CONCLUSIONS: A small proportion of the population obtained ambulatory care from a high number of physicians during the year, leading to high expenses. Identifying and understanding this type of frequent user may be useful in developing strategies to promote more effective health-care-seeking behaviours and reduce overuse.     

Early detection of visual defects in infancy

To determine the part played by screening in detecting visual defects questionnaires were sent to 240 families with blind or partially sighted children identified from the Family Fund's database. Questions were asked on social and family background, the visual disorder and its severity, any other disability, and how and when the disabilities were discovered and subsequently managed. Data from 189 families were analysed, constituting all those with children with major visual defects from the 219 families who replied. The visual defect was first discovered in 111 children by parents, friends, and neighbours, and in 36 by a doctor at the neonatal examination. In only three children who did not have a family history of visual impairment was the defect discovered during a formal screening examination at a child health clinic. Dissatisfaction about medical services was expressed by about a third of the parents, particularly a lack of provision of information and consideration of their worries and a failure to refer the child promptly to educational and treatment services. Visual defects in children under 5 are generally detected by family and friends, not by screening, but detection by the medical profession could be improved by increased awareness and observation and quick referral.     

Child sexual abuse--children and families referred to a treatment project and the effects of intervention

The characteristics of a series of 274 families who were referred to a sexual abuse treatment programme were analysed. Information was obtained on 411 abused children and 362 non-abused children. Different forms of sexual abuse were noted, with 77% of girls and 23% of boys affected. Boys tended to be abused at a younger age, more severely, and for longer periods than girls. There was a predominance of lower social class groups among the parents, and a wide variety of family structures, with reasonable stability over time. Ninety six per cent of perpetrators were men, and biological and step-parents predominated. Contributing factors in both the family history and the current perpetrators and their wives included sexual abuse, violence, chaotic families, marital problems, sexual difficulties, alcoholism, and subnormality. Follow up of 120 families, 180 victims, and 226 siblings showed that prosecution occurred in 60% of cases, with a high percentage of perpetrators being imprisoned. Treatment was offered to 87% of families, but because the treatment programme was in the early stages of development a variable number of children and parents were offered family treatment or treatment in groups for parents and children separately. There was an improvement in the victim's circumstances in 61% of cases, and a noticeable reduction in "sexualised" and general emotional difficulties among victims, but there was reabuse rate of 16%. Protection of children was achieved through changes of family attitude and changes in family structure including divorce and separation: 14% of victims were rehabilitated to both parents, 33% to mothers only, and 26% to new families or other residences. Consensus in the family that abuse had occurred was seen as an important factor in determining which children could be rehabilitated with both their parents, with their mothers only, or with new families; which families could be offered or accepted treatment; and whether positive changes in the family occurred.     

Family planning in Melbourne: a medical-social project

The 1st 12 months of operation of a family planning clinic, established by the Brotherhood of St. Laurence in a low income district of Melbourne, Australia, was assessed. The Brotherhood decided to establish the clinic despite the attitude on the part of the medical and social work personnel that the demand for family planning services among low income groups was insignificant. The Brotherhood believed that it was not possible to assess the demand since the services had never been made widely available to the city's poor. During the initial 12 months of operation, 185 patients utilized the services of the clinic and they made a total of 208 return visits. The majority of the patients were referred to the clinic by public hospitals or by the Brotherhood. 72% of the patients had incomes below $50 a week, which is the standard used to denote limited means in Australia. 79 of the 185 patients had only 2 or 3 children. Many of the patients came to the clinic from outside the district. 126 of the patients chose oral contraceptives, 46 chose IUDs, 6 chose the diaphragm, and 2 chose the ovulation method. Patients paid according to their income, and no one was turned away because of inability to pay. Husbands and wives were urged to attend, and the clinic was open in the evening to accommodate clients who worked during the day. The Brotherhood is a welfare organization and normally does not provide family planning services. It is too early to determine whether the services will be used sufficiently to justify the government or some other organization setting up a permanent clinic in the district. At the present time the Brotherhood is planning to continue operating the clinic and is also planning to conduct an attitudal survey among the residents of the district.     

The assessment of patients' waiting and nursing consultation times at urban clinics in the National Capital District, Papua New Guinea

This study was conducted in the National Capital District during the months of August, September and October 2000. The study sites were the 3 urban clinics situated in the suburbs of Six Mile, Hohola and Konedobu. The aim of the study was to determine the patients' waiting times and nursing consultation times in the urban clinics. A total of 1075 patients were surveyed, including 264 children under 5 years of age. 58% of patients were males. 24% of patients were able to see a nurse within 30 minutes and 70% within 2 hours. 47% had to wait 1-3 hours to see a consulting nurse and a further 9.5% had to wait 3-5 hours. 67% of nursing consultations were 5 minutes or less, which is too short to interview, examine and prescribe treatment for the patients and to use the Paediatric 10 Steps. The short consultations of 5 minutes or less did not involve children under 5 years of age. There were only one to two nurses seeing the patients when 79% of patients were seen. This explains why the patients' waiting time was long. After consultations many patients (71%) were able to get their treatment within 30 minutes but 28% had to wait from 30 minutes to 2 hours for their treatment. The small number of nurses giving treatment leads to long waiting times. From the time of entry to exit out of the clinic, only 11% of patients spent 30 minutes or less in the clinic while 51% spent between 1 and 3 hours. The patients' waiting times and the short nursing consultation times are directly related to the insufficient number of nursing officers working in the clinics.     

家长对小学生家庭医生签约服务的需求及意愿研究

背景　成都市武侯区自2011年以来大力开展家庭医生签约服务并取得一定成效,但尚缺乏针对小学生的家庭医生签约服务,了解我区小学生家长的家庭医生签约服务需求和签约意愿及其影响因素,有利于进一步扩大家庭医生的服务范围和覆盖率。目的　了解武侯区小学生家长对于小学生家庭医生签约服务的需求,评估小学生家庭医生签约服务意愿,探讨影响小学生家庭医生签约服务的影响因素,为进一步开展小学生家长家庭医生签约服务工作提供建议。方法　随机抽取成都市武侯区3所小学,并于2019年9-12月采用问卷调查的方式,对被抽取的3所小学的所有符合条件的小学生家长进行横断面调查,调查的主要内容为家长基本情况、签约服务需求及签约意愿。向2 991例小学生家长发放问卷,回收有效问卷2 988份,问卷有效率为99.90%。结果　55.29%（1 652/2 988）小学生家长为一到三年级小学生的家长。544例（18.20%）家长签约家庭医生后最希望孩子可以享受健康教育服务,424例（14.19%）家长最希望孩子接受视力保健知识方面的健康教育服务;从小学生疾病诊疗需求角度,463例（15.50%）家长最希望家庭医生能联系口腔科专科资源;753例（25.20%）家长认为小学生签约家庭医生最大的优势是可及性好。2 293例（76.74%）小学生家长有意愿为孩子签约家庭服务,不同小学生所处年级、家庭平均年收入、家庭成员最高文化程度、被调查家长职业、是否知道最近的社区卫生服务中心（站）的具体位置和是否听过或者接受过家庭医生签约服务的小学生家长的签约意愿比较,差异有统计学意义（P<0.05）。多因素Logistic 回归分析结果显示,影响小学生家长为孩子签订家庭医生签约服务的因素主要为小学生所处年级、家庭平均年收入、家庭成员最高文化程度、被调查家长职业和是否听过或者接受过庭医生签约服务（P<0.05）。结论　成都市武侯区小学生家长对促进小学生健康管理的关注度高,为小学生签订家庭医生签约服务的意愿较大。高家庭年收入水平和高学历家长可能将促进签约服务的达成。     

A survey of the use of prostitutes (commercial sex workers) by new male attenders at a genito urinary medicine clinic.

This study documents the use of prostitutes (commercial sex workers) by new male patients attending a genito urinary medicine clinic. 541 consecutive male patients completed an anonymous self-administered questionnaire. 48 (8.9%) gave a history of previous purchase of sexual services in Northern Ireland and/or elsewhere; 69% of these encounters occurred outside Northern Ireland. The largest group were single men aged 20-29 years. 87% of those who purchased services in Northern Ireland were asked by the prostitute to use a condom compared with 60% elsewhere, but there was no significant difference in actual condom use between both groups (66.7% vs 72.7%) Only 21% of patients who had purchased the services more than once used condoms consistently and 29% were willing to pay more for unprotected sexual intercourse. 40% attributed their attendance at this clinic directly or indirectly to their encounter with a prostitute. Encounters with prostitutes were often related to alcohol consumption, 88% sometimes or always purchasing these services after drinking alcohol. Despite widespread publicity at-risk behaviour involving unprotected sexual intercourse with prostitutes is not uncommon. Health education should be targeted at the young single male who travels outside Northern Ireland.     

Survey of parents' attitudes to the recommended Haemophilus influenzae type b vaccine program.

A survey was conducted in a general pediatric practice to determine parents' attitudes to and compliance with the recommended Haemophilus influenzae type b vaccine program. Of 133 families surveyed 127 (95%) responded to the questionnaire. About one third of the parents did not have their children vaccinated. The decision against vaccination was made despite parent education, follow-up telephone contact and the pediatrician's expressed support of the vaccine program. Most of the respondents (86%) had no previous knowledge of the vaccine. The factor of greatest concern was the possibility of an adverse reaction. This concern was significantly more common among the parents who decided not to have their children vaccinated than among those who had their children vaccinated (chi 2 = 6.52, p less than 0.025). One third of the parents who indicated that they intended to have their children vaccinated required a telephone reminder. The findings suggest a need for public education about the vaccine, with particular emphasis directed at allaying fears about side effects.     

Death certification in general practice: review of records

The records of death that had been certified by general practitioners in one practice over 18 years were assessed in the light of the recent joint publications of the Royal College of Physicians and the Royal College of Pathologists. Over this period roughly 30% of the deaths in the practice population occurred outside hospital and a total of 262 certificates were issued. A review of 262 counterfoils of records of death certification showed that 12 counterfoils (4.6%) had no age and sex mentioned, and three counterfoils did not describe the place of death. The average age at death outside hospital was 71.6 years--the age of women being 75.1 years compared with that of men of 68.2 years. Only 2% of patients had had a necropsy. The common causes of death stated in the certificates were: cardiovascular 41%, carcinoma 35%, respiratory 15%, and stroke 8%. All contributory causes are also mentioned. Ninety seven per cent of the patients were seen after death by the doctors in the practice and 68% had been seen in the two days preceding death. We emphasise the importance of keeping accurate records of deaths in general practice for audit and research as well as for planning services for terminally ill and recently bereaved patients.     

Experiences and views of general practitioners concerning sexually-abused children

This study aimed to determine the types of clinical experience that general practitioners have had with sexually-abused children, and what practitioners perceive as requirements in the detection and management of sexually-abused children. Subjects were 279 South Australian non-specialist medical practitioners, selected by quasi-random procedures, of whom 76% responded to a postal questionnaire. The number of sexually-abused children ever seen by the 193 doctors who responded averaged 1.2; 54% of the respondents had not seen such cases. In addition to the request for a record of experiences with sexually-abused children, the questionnaire included categories on: sources of the respondents' information on sexually-abused children; the respondents' perceived need for more information; an assessment of the adequacy of current treatment services; their attitudes to the legal obligation to report suspected cases to statutory authorities; and the main sources of their hesitation to report. Considerable concern evidently exists among family doctors about their ability to detect and manage cases of sexually-abused children. The reasons for their low reporting rates are discussed in terms of both medical education and of the operation of local treatment services for sexually-abused children.     

Which physicians make home visits and why? A survey

BACKGROUND: Recent changes in the North American health care system and certain demographic factors have led to increases in home care services. Little information is available to identify the strategies that could facilitate this transformation in medical practice and ensure that such changes respond adequately to patients' needs. As a first step, the authors attempted to identify the major factors influencing physicians' home care practices in the Quebec City area. METHODS: A self-administered questionnaire was sent by mail to all 696 general practitioners working in the Quebec City area. The questionnaire was intended to gather information on physicians' personal and professional characteristics, as well as their home care practice (practice volume, characteristics of both clients and home visits, and methods of patient assessment and follow-up). RESULTS: A total of 487 physicians (70.0%) responded to the questionnaire, 283 (58.1%) of whom reported making home visits. Of these, 119 (42.0%) made fewer than 5 home visits per week, and 88 (31.1%) dedicated 3 hours or less each week to this activity. Physicians in private practice made more home visits than their counterparts in family medicine units and CLSCs (centres locaux des services communautaires [community centres for social and health services]) (mean 11.5 v. 5.8 visits per week), although the 2 groups reported spending about the same amount of time on this type of work (mean 5.6 v. 5.0 hours per week). The proportion of visits to patients in residential facilities or other private residences was greater for private practitioners than for physicians from family medicine units and CLSCs (29.7% v. 18.9% of visits), as were the proportions of visits made at the patient's request (28.0% v. 14.2% of visits) and resulting from an acute condition (21.4% v. 16.0% of visits). The proportion of physicians making home visits at the request of a CLSC was greater for those in family medicine units and CLSCs than for those in private practice (44.0% v. 11.3% of physicians), as was the proportion of physicians making home visits at the request of a colleague (18.0% v. 4.5%) or at the request of hospitals (30.0% v. 6.8%). Physicians in family medicine units and CLSCs did more follow-ups at a frequency of less than once per month than private practitioners (50.9% v. 37.1% of patients), and they treated a greater proportion of patients with cognitive disorders (17.2% v. 12.6% of patients) and palliative care needs (13.7% v. 8.6% of patients). Private practitioners made less use of CLSC resources to assess home patients or follow them. Male private practitioners made more home visits than their female counterparts (mean 12.8 v. 8.3 per week), although they spent an almost equal amount of time on this activity (mean 5.7 v. 5.2 hours per week). INTERPRETATION: These results suggest that practice patterns for home care vary according to the physician's practice setting and sex. Because of foreseeable increases in the numbers of patients needing home care, further research is required to evaluate how physicians' practices can be adapted to patients' needs in this area.