{"id":2155,"date":"2021-07-08T09:05:31","date_gmt":"2021-07-08T00:05:31","guid":{"rendered":"https:\/\/www.hcfm.jp\/journal\/?p=2155"},"modified":"2021-07-08T09:05:31","modified_gmt":"2021-07-08T00:05:31","slug":"%e5%ae%b6%e5%ba%ad%e5%8c%bb%e3%81%8c%e6%82%a3%e8%80%85%e3%81%8b%e3%82%89%e3%81%ae%e8%a6%81%e6%b1%82%e3%82%92%e5%a6%a5%e5%bd%93%e3%81%a7%e3%81%af%e3%81%aa%e3%81%84%e3%81%a8%e6%84%9f%e3%81%98%e3%80%81","status":"publish","type":"post","link":"https:\/\/www.hcfm.jp\/journal\/?p=2155","title":{"rendered":"\u5bb6\u5ead\u533b\u304c\u60a3\u8005\u304b\u3089\u306e\u8981\u6c42\u3092\u59a5\u5f53\u3067\u306f\u306a\u3044\u3068\u611f\u3058\u3001\u305d\u306e\u307e\u307e\u53d7\u3051\u5165\u308c\u308b\u306e\u3082\u3001\u62d2\u5426\u3059\u308b\u306e\u3082\u3044\u305a\u308c\u3082\u96e3\u3057\u3044\u6642\u306b\u3069\u3046\u5bfe\u5fdc\u3059\u308b\u304b -\u30d5\u30a9\u30fc\u30ab\u30b9\u30b0\u30eb\u30fc\u30d7\u7814\u7a76-"},"content":{"rendered":"

\u2015\u6587\u732e\u540d\u2015
\nJ\u00f8rgen Breivold, Karin Isaksson R\u00f8, Stef\u00e1n Hj\u00f6rleifsson, Conditions for gatekeeping when GPs consider patient requests unreasonable: a focus group study, Family Practice, 2021;, cmab072, https:\/\/doi.org\/10.1093\/fampra\/cmab072<\/a><\/p>\n

\u2015\u8981\u7d04\u2015
\nBackground<\/strong>: \u60a3\u8005\u304b\u3089\u306e\u8981\u6c42\u3092\u5bb6\u5ead\u533b\u304c\u59a5\u5f53\u3067\u306f\u306a\u3044\u3068\u8003\u3048\u308b\u3088\u3046\u306a\u5834\u5408\u3001\u305d\u308c\u306f\u3001\u5bb6\u5ead\u533b\u3068\u60a3\u8005\u306e\u9593\u3067\u306e\u885d\u7a81\u306e\u3082\u3068\u306b\u306a\u308a\u3046\u308b\u3002\u305d\u3046\u3057\u305f\u6642\u306b\u3001\u30b2\u30fc\u30c8\u30ad\u30fc\u30d4\u30f3\u30b0\u306f\u96e3\u3057\u3044\u3082\u306e\u3068\u306a\u308b\u3002\u306a\u305c\u306a\u3089\u3001\u5bb6\u5ead\u533b\u306f\u3001\u533b\u5e2b\u60a3\u8005\u95a2\u4fc2\u3092\u4fdd\u3064\u3053\u3068\u3068\u3001\u533b\u7642\u306e\u904e\u5270\u5229\u7528\u306b\u3088\u308b\u5bb3\u304b\u3089\u60a3\u8005\u3092\u5b88\u308b\u3053\u3068\u3001\u305d\u3057\u3066\u3001\u6709\u9650\u306a\u30d8\u30eb\u30b9\u30b1\u30a2\u30ea\u30bd\u30fc\u30b9\u306e\u7ba1\u7406\u8005\u3068\u3057\u3066\u632f\u308b\u821e\u3046\u3053\u3068\u306e\u9593\u306e\u305b\u3081\u304e\u5408\u3044\u306e\u4e2d\u3067\u6298\u308a\u5408\u3044\u3092\u3064\u3051\u306a\u3051\u308c\u3070\u306a\u3089\u306a\u3044\u305f\u3081\u3067\u3042\u308b\u3002\u305d\u306e\u3088\u3046\u306a\u56f0\u96e3\u306a\u8a3a\u7642\u3092\u5bb6\u5ead\u533b\u304c\u3069\u3046\u3084\u3063\u3066\u3046\u307e\u304f\u53ce\u3081\u3066\u3044\u308b\u306e\u304b\u306b\u3064\u3044\u3066\u3001\u66f4\u306a\u308b\u77e5\u8b58\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002<\/p>\n

Objective<\/strong>: \u30ce\u30eb\u30a6\u30a7\u30fc\u306e\u5bb6\u5ead\u533b\u304c\u3001\u59a5\u5f53\u3067\u306f\u306a\u3044\u3068\u8003\u3048\u308b\u3088\u3046\u306a\u60a3\u8005\u304b\u3089\u306e\u8981\u6c42\u3092\u53d7\u3051\u305f\u969b\u306b\u3001\u3069\u306e\u3088\u3046\u306a\u72b6\u6cc1\u304c\u3042\u308c\u3070\u3001\u305d\u306e\u4e2d\u3067\u3082\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u3068\u3057\u3066\u306e\u5f79\u5272\u3092\u679c\u305f\u3059\u80fd\u529b\u304c\u3072\u304d\u3060\u3055\u308c\u308b\u304b\u3092\u63a2\u7d22\u3059\u308b<\/p>\n

Methods<\/strong>: 2019\u5e74\u306b\u30013\u56de\u306e\u30ce\u30eb\u30a6\u30a7\u30fc\u306e\u5bb6\u5ead\u533b\u306e\u30d5\u30a9\u30fc\u30ab\u30b9\u30b0\u30eb\u30fc\u30d7\u306b\u57fa\u3065\u3044\u305f\u8cea\u7684\u8abf\u67fb\u3092\u884c\u306a\u3063\u305f\u3002\u305d\u306e\u4e2d\u3067\u3001\u60a3\u8005\u304c\u4e00\u898b\u59a5\u5f53\u3067\u306f\u306a\u3044\u8981\u6c42\u3092\u3057\u3066\u304d\u305f\u304c\u3001\u5bb6\u5ead\u533b\u304c\u81e8\u5e8a\u7684\u306b\u9069\u5207\u306a\u5f62\u3067\u8a3a\u7642\u3092\u53ce\u3081\u308b\u3053\u3068\u304c\u3067\u304d\u305f\u3088\u3046\u306a\u5916\u6765\u306b\u3064\u3044\u3066\u8abf\u67fb\u3057\u305f\u3002Thematic crosscase analysis\u3092\u3001Systematic Text Condensation\u3092\u7528\u3044\u3066\u305d\u306e\u30d5\u30a9\u30fc\u30ab\u30b9\u30b0\u30eb\u30fc\u30d7\u306e\u9010\u8a9e\u9332\u3092\u3082\u3068\u306b\u884c\u306a\u3063\u305f\u3002<\/p>\n

Results<\/strong>: \u5bb6\u5ead\u533b\u304c\u60a3\u8005\u306e\u59a5\u5f53\u3067\u306f\u306a\u3044\u8981\u6c42\u306b\u76f4\u9762\u3057\u305f\u6642\u306b\u52a9\u3051\u306b\u306a\u308b\u72b6\u6cc1\u3068\u3057\u3066\u4ee5\u4e0b\u306e\u4e09\u3064\u306e\u30c6\u30fc\u30de\u304c\u898b\u51fa\u3055\u308c\u305f\u3002
\n(i) communication skills for mutual understanding and trust
\n\u30fb\u60a3\u8005\u306e\u8981\u6c42\u304c\u59a5\u5f53\u3067\u306a\u3044\u3068\u611f\u3058\u308b\u306e\u306f\u3001\u5bb6\u5ead\u533b\u304c\u305d\u306e\u80cc\u666f\u306e\u4e8b\u60c5\u3084\u6587\u8108\u3092\u7406\u89e3\u3057\u3066\u3044\u306a\u3044\u30b5\u30a4\u30f3\u3067\u3042\u308b\u3068\u8003\u3048\u308b
\n\u30fb\u5bb6\u5ead\u533b\u304c\u305d\u3046\u611f\u3058\u308b\u3060\u3051\u3067\u306f\u4e0d\u5341\u5206\u3067\u3001\u8a3a\u7642\u306e\u4e2d\u3067\u3001\u60a3\u8005\u304c\u305d\u306e\u8981\u6c42\u306e\u80cc\u5f8c\u306b\u3042\u308b\u61f8\u5ff5\u3092\u5bb6\u5ead\u533b\u306b\u7406\u89e3\u3057\u3066\u3082\u3089\u3048\u305f\u3068\u3044\u3046\u571f\u53f0\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002\u3088\u3063\u3066\u3001\u5bb6\u5ead\u533b\u306f\u3001\u60a3\u8005\u5074\u306e\u8996\u70b9\u306b\u5bfe\u3057\u3066\u5c0a\u91cd\u3092\u793a\u3057\u3001\u60a3\u8005\u304c\u3084\u308a\u3068\u308a\u306b\u3088\u308a\u95a2\u308f\u308b\u3088\u3046\u4fc3\u3059\u5fc5\u8981\u304c\u3042\u308b
\n\u30fb\u60a3\u8005\u304b\u3089\u4fe1\u983c\u3092\u5f97\u308b\u305f\u3081\u306e\u6226\u7565\u306f\u5bb6\u5ead\u533b\u306b\u3088\u3063\u3066\u7570\u306a\u3063\u305f\u3066\u3044\u305f\uff1a
\n\u4f8b\uff1a\u81ea\u8eab\u306e\u904e\u53bb\u306e\u533b\u7642\u7d4c\u9a13\u3092\u5f37\u8abf\u3057\u3066\u793a\u3059\u3001\u8a3a\u5bdf\u3092\u4e01\u5be7\u306b\u884c\u3046\u3053\u3068\u3067\u305d\u306e\u5f8c\u306e\u4e3b\u5f35\u306b\u7b94\u3092\u3064\u3051\u308b\u3001\u306a\u3069
\n\u30fb\u60a3\u8005\u306e\u8996\u70b9\u306b\u5171\u611f\u3057\u3064\u3064\u3082\u3001\u7684\u78ba\u306a\u8aac\u660e\u3092\u884c\u3046\u3053\u3068\u3067\u8aa4\u89e3\u304c\u3042\u308c\u3070\u305d\u308c\u304c\u3069\u3053\u306a\u306e\u304b\u306f\u3063\u304d\u308a\u3055\u305b\u308b\u3053\u3068\u3067\u306f\u3058\u3081\u3066\u3001\u60a3\u8005\u304c\u5f53\u521d\u8981\u6c42\u3057\u3066\u3044\u305f\u5185\u5bb9\u3068\u306f\u9055\u3046\u7d50\u672b\u306b\u8a3a\u7642\u304c\u306a\u3063\u3066\u3082\u305d\u308c\u3092\u53d7\u3051\u5165\u308c\u308b\u3053\u3068\u304c\u3067\u304d\u308b\u53ef\u80fd\u6027\u304c\u51fa\u3066\u304f\u308b<\/p>\n

(ii) a long-term perspective
\n\u30fb\u6642\u9593\u304c\u7d4c\u3064\u3053\u3068\u3067\u304a\u4e92\u3044\u304c\u304a\u4e92\u3044\u306e\u8996\u70b9\u306b\u5bdb\u5bb9\u306b\u306a\u308a\u3001\u5354\u8abf\u3067\u304d\u308b\u3088\u3046\u306b\u306a\u3063\u3066\u3044\u304f\u30d7\u30ed\u30bb\u30b9\u3092\u7814\u7a76\u53c2\u52a0\u8005\u306f\u8a71\u3057\u3066\u3044\u305f
\n\u4f8b\u3048\u3070\u3001\u60a3\u8005\u5074\u306f\u3001\u3053\u306e\u5bb6\u5ead\u533b\u306f\u6700\u5f8c\u307e\u3067\u304d\u3063\u3061\u308a\u9762\u5012\u3092\u307f\u308b\u3053\u3068\u3084\u3001\u30d5\u30a9\u30ed\u30fc\u304c\u5fc5\u8981\u306b\u306a\u3063\u3066\u3082\u3057\u3063\u304b\u308a\u5bfe\u5fdc\u3057\u3066\u304f\u308c\u308b\u3053\u3068\u3092\u7d4c\u9a13\u3059\u308b\u3053\u3068\u3067\u3001\u533b\u5e2b\u5074\u306f\u3001\u60a3\u8005\u306e\u7f6e\u304b\u308c\u305f\u72b6\u6cc1\u306e\u5177\u4f53\u6027\u30fb\u56fa\u6709\u6027\u306b\u8a73\u3057\u304f\u306a\u308b\u3053\u3068\u3067\u306f\u3058\u3081\u306f\u59a5\u5f53\u3067\u306a\u3044\u3068\u611f\u3058\u305f\u8981\u6c42\u306b\u3064\u3044\u3066\u3082\u4f55\u3089\u304b\u306e\u5bfe\u5fdc\u304c\u3067\u304d\u308b\u3088\u3046\u306b\u306a\u3063\u3066\u3044\u304f
\n\u30fb\u60a3\u8005\u3068\u306e\u8acd\u3044\u3092\u907f\u3051\u3059\u304e\u308b\u3068\u3001\u533b\u5e2b\u3068\u3057\u3066\u306e\u4e00\u8cab\u6027\u306f\u4fdd\u3066\u306a\u3044\u4e00\u65b9\u3067\u3001\u533b\u5b66\u7684\u8996\u70b9\u306b\u3053\u3060\u308f\u308b\u3068\u3001\u8a3a\u7642\u5168\u3066\u3067\u3088\u3044\u7d50\u679c\u3092\u51fa\u3057\u3066\u3044\u304f\u3053\u3068\u304c\u3067\u304d\u306a\u3044\u305f\u3081\u3001\u67d4\u8edf\u306a\u59ff\u52e2\u3067\u554f\u984c\u89e3\u6c7a\u306b\u81e8\u3080\u3053\u3068\u304c\u4fe1\u983c\u306b\u3064\u306a\u304c\u308b\u3057\u3001\u53b3\u5bc6\u3059\u304e\u308b\u3068\u60a3\u8005\u3068\u885d\u7a81\u3059\u308b\u3060\u3051\u3067\u3042\u308b\u3002\u4ea4\u6e09\u306e\u4f59\u5730\u306f\u30b1\u30fc\u30b9\u3054\u3068\u306b\u7570\u306a\u308a\u3001\u6642\u306b\u306f\u53d7\u3051\u5165\u308c\u53ef\u80fd\u306a\u7bc4\u56f2\u3067\u306e\u59a5\u5354\u304c\u5fc5\u8981\u3068\u306a\u308b(\u5916\u79d1\u306b\u306f\u7d39\u4ecb\u3067\u304d\u306a\u3044\u304c\u3001\u7406\u5b66\u7642\u6cd5\u306a\u3089\u3067\u304d\u308b\u3001\u306a\u3069)<\/p>\n

(iii) Support of the gatekeeper function
\n\u30b2\u30fc\u30c8\u30ad\u30fc\u30d4\u30f3\u30b0\u306e\u5f79\u5272\u306f\u3001\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u3078\u306e\u8981\u6c42\u304c\u9ad8\u304f\u306a\u308a\u3001\u60a3\u8005\u306e\u6d88\u8cbb\u8005\u4e3b\u7fa9\u7684\u306a\u614b\u5ea6\u3092\u4fc3\u9032\u3059\u308b\u793e\u4f1a\u7684\u306a\u529b\u306e\u305f\u3081\u306b\u3001\u307e\u3059\u307e\u3059\u56f0\u96e3\u306b\u306a\u3063\u3066\u3044\u308b\u3002\u60a3\u8005\u306f\u30b2\u30fc\u30c8\u30ad\u30fc\u30d4\u30f3\u30b0\u306e\u5f79\u5272\u3092\u8a8d\u8b58\u3057\u3001\u305d\u308c\u304cGP\u306b\u6c42\u3081\u3089\u308c\u3066\u3044\u308b\u3053\u3068\u3092\u524d\u63d0\u3068\u3057\u3066\u77e5\u308b\u5fc5\u8981\u304c\u3042\u308b\u3002\u5c02\u9580\u8077\u3068\u3057\u3066\u306e\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u6280\u8853\u304a\u3088\u3073\u95a2\u4fc2\u6027\u306e\u7d99\u7d9a\u6027\u306b\u91cd\u70b9\u3092\u304a\u304f\u3053\u3068\u306b\u3088\u3063\u3066\u3001\u5bb6\u5ead\u533b\u306f\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u3068\u3057\u3066\u306e\u5f79\u5272\u3092\u7dad\u6301\u3059\u308b\u3053\u3068\u304c\u53ef\u80fd\u3068\u306a\u308b\u3002
\n(\u305d\u308c\u3060\u3051\u3067\u306a\u304f)\u5c02\u9580\u8077\u306e\u4e2d\u304a\u3088\u3073\u793e\u4f1a\u304b\u3089\u3001\u305d\u3046\u3057\u305f\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u306e\u5f79\u5272\u3092\u652f\u3048\u308b\u3088\u3046\u306a\u8996\u70b9\u3082\u5fc5\u8981\u3067\u3042\u308b\u3002\u3053\u308c\u306f\u3001GP\u81ea\u8eab\u306e\u8cac\u4efb\u3067\u3082\u3042\u308b\u3068\u7814\u7a76\u53c2\u52a0\u8005\u306f\u8ff0\u3079\u3066\u3044\u305f\u3002GP\u306f\u3001\u60a3\u8005\u304c\u533b\u5e2b\u306b\u671f\u5f85\u3057\u3066\u7136\u308b\u3079\u304d\u3053\u3068\u3092\u4f1d\u3048\u308b\u3079\u304f\u516c\u306e\u8b70\u8ad6\u306b\u53c2\u52a0\u3059\u3079\u304d\u3067\u3042\u308a\u3001GP\u9593\u3067\u3001\u610f\u898b\u306e\u5272\u308c\u308b\u533b\u7642\u554f\u984c\u306b\u3064\u3044\u3066\u3088\u308a\u610f\u898b\u3092\u7d71\u4e00\u3067\u304d\u308b\u3088\u3046\u52aa\u529b\u3059\u3079\u304d\u3068\u3057\u305f\u3002\u3057\u304b\u3057\u3001GP\u306e\u30b2\u30fc\u30c8\u30ad\u30fc\u30d4\u30f3\u30b0\u306e\u5f79\u5272\u306f\u3001\u516c\u7684\u6a5f\u95a2\u304b\u3089\u306e\u516c\u5f0f\u60c5\u5831\u3067\u3082\u8aac\u660e\u3055\u308c\u308b\u3079\u304d(\u4f8b\uff1a\u6297\u751f\u7269\u8cea\u306e\u904e\u5270\u5229\u7528\u3092\u907f\u3051\u308b\u5e83\u5831\u6d3b\u52d5\u306b\u3088\u3063\u3066\u98a8\u90aa\u3078\u306e\u6297\u751f\u7269\u8cea\u306e\u4f7f\u7528\u3092\u907f\u3051\u308b\u3053\u3068\u3092\u8aac\u660e\u3057\u3084\u3059\u304f\u306a\u3063\u305f)\u3067\u3042\u308a\u3001\u305d\u308c\u306b\u3088\u3063\u3066GP\u306e\u5f79\u5272\u306b\u306f\u533b\u7642\u306e\u904e\u5270\u5229\u7528\u304b\u3089\u60a3\u8005\u3092\u5b88\u308b\u3053\u3068\u3084\u3001\u5171\u6709\u8cc7\u6e90\u306e\u7ba1\u7406\u8005\u3068\u3057\u3066\u306e\u5f79\u5272\u304c\u542b\u307e\u308c\u308b\u3053\u3068\u304c\u6b63\u5f53\u5316\u3055\u308c\u308b\u3002<\/p>\n

Discussion<\/strong>
\n\u5185\u5bb9\u306b\u3064\u3044\u3066\uff1a
\n\u60a3\u8005\u304b\u3089\u306e\u59a5\u5f53\u3067\u306f\u306a\u3044\u8981\u6c42\u306b\u5bfe\u51e6\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u60a3\u8005\u306e\u8996\u70b9\u3092\u63a2\u308a\u3001\u305d\u306e\u59a5\u5f53\u6027\u3092\u8a8d\u3081\u3001\u4fe1\u983c\u3092\u7bc9\u304f\u305f\u3081\u306e\u7279\u5b9a\u306e\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u30b9\u30ad\u30eb\u304c\u5fc5\u8981\u3067\u3042\u308b\u3068\u3044\u3046\u3053\u308c\u307e\u3067\u306e\u7814\u7a76\u7d50\u679c\u306b\u5408\u81f4\u3059\u308b\u3082\u306e\u3060\u3063\u305f\u3002
\n\u672c\u7814\u7a76\u3067\u306f\u3001GP\u5074\u306e\u67d4\u8edf\u306a\u614b\u5ea6\u3084\u95a2\u4fc2\u6027\u306e\u7d99\u7d9a\u6027\u304c\u91cd\u8981\u3067\u3042\u308a\u3001\u5148\u884c\u7814\u7a76\u306b\u304a\u3051\u308bGP\u304c\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u306e\u5f79\u5272\u3092\u679c\u305f\u3059\u305f\u3081\u306b\u3001\u7af6\u5408\u3059\u308b\u8981\u7d20\u306e\u9593\u3067\u59a5\u5354\u3092\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u7d50\u679c\u3068\u5408\u81f4\u3059\u308b\u3082\u306e\u3060\u3063\u305f\u3002
\n\u307e\u305f\u3001\u30d7\u30e9\u30a4\u30de\u30ea\u30b1\u30a2\u306b\u304a\u3051\u308b\u95a2\u4fc2\u6027\u306e\u7d99\u7d9a\u6027\u306f\u3001\u6b7b\u4ea1\u7387\u3084\u3001\u5c02\u9580\u5bb6\u306e\u5229\u7528\u3092\u6e1b\u3089\u3057\u3064\u3064\u3001\u30b9\u30bf\u30c3\u30d5\u3068\u60a3\u8005\u306e\u6e80\u8db3\u5ea6\u3092\u3042\u3052\u308b\u3068\u3044\u3046\u7814\u7a76\u3082\u3042\u308b\u3002
\n\u672c\u7814\u7a76\u306e\u672c\u8cea\u306f\u3001\u5bb6\u5ead\u533b\u304c\u3001\u975e\u73fe\u5b9f\u7684\u306a\u533b\u7642\u306b\u5bfe\u3059\u308b\u671f\u5f85\u306b\u7531\u6765\u3059\u308b\u60a3\u8005\u3068\u306e\u610f\u898b\u306e\u4e0d\u4e00\u81f4\u3092\u89e3\u6d88\u3059\u308b\u306b\u306f\u3001\u793e\u4f1a\u304b\u3089\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u306e\u5f79\u5272\u3092\u8a8d\u3081\u3089\u308c\u3066\u3044\u308b\u5fc5\u8981\u304c\u3042\u308b\u3068\u3044\u3046\u70b9\u3067\u3042\u308b\u3002\u30d7\u30ed\u30d5\u30a7\u30c3\u30b7\u30e7\u30ca\u30ea\u30ba\u30e0\u306e\u7406\u8ad6\u306b\u3088\u308b\u3068\u3001\u3042\u308b\u5c02\u9580\u8077\u306e\u6a29\u5a01\u306f\u3001\u305d\u306e\u30e1\u30f3\u30d0\u30fc\u304c\u516c\u5171\u306e\u5229\u76ca\u306e\u305f\u3081\u306e\u7279\u5b9a\u306e\u30bf\u30b9\u30af\u3092\u5b9f\u884c\u3059\u308b\u305f\u3081\u306b\u81ea\u5206\u306e\u30b9\u30ad\u30eb\u3092\u63a1\u7528\u3059\u3079\u304d\u3067\u3042\u308a\u3001\u5c02\u9580\u8077\u304c\u975e\u5c02\u9580\u5bb6\u3088\u308a\u3082\u3053\u308c\u3089\u306e\u30bf\u30b9\u30af\u3092\u7ba1\u7406\u3059\u308b\u306e\u306b\u9069\u3057\u3066\u3044\u308b\u3068\u3044\u3046\u5408\u610f\u306b\u4f9d\u5b58\u3057\u3066\u3044\u308b(25)\u3002\u3055\u3089\u306b\u306f\u3001\u5c02\u9580\u8077\u306e\u6b63\u5f53\u6027\u306f\u3001\u305d\u306e\u5b9f\u8df5\u306e\u571f\u53f0\u3068\u306a\u308b\u9593\u4e3b\u89b3\u7684\u306a\u898f\u7bc4\u306b\u3064\u3044\u3066\u306e\u5e45\u5e83\u3044\u5408\u610f\u306b\u4f9d\u5b58\u3057\u3066\u3044\u308b\u3002\u533b\u7642\u30b5\u30fc\u30d3\u30b9\u306e\u5546\u54c1\u5316\u3084\u5546\u696d\u5316\u3001\u533b\u7642\u60c5\u5831\u3084\u533b\u7642\u6280\u8853\u306e\u666e\u53ca\u306f\u3001\u4f55\u304c\u60a3\u8005\u306e\u5229\u76ca\u306b\u306a\u308b\u304b\u3068\u3044\u3046\u533b\u5e2b\u306e\u5224\u65ad\u306b\u5bfe\u3059\u308b\u60a3\u8005\u306e\u4fe1\u983c\u3092\u3042\u308b\u7a0b\u5ea6\u640d\u306a\u3063\u3066\u3044\u308b\u3088\u3046\u306b\u601d\u308f\u308c\u308b(29)\u3002\u5148\u884c\u7814\u7a76\u306b\u3088\u308b\u3068\u3001\u62d2\u5426\u306e\u4ea4\u6e09\u3092\u3059\u308b\u969b\u306b\u3001\u9577\u5e74\u306e\u60a3\u8005\u3068\u533b\u5e2b\u306e\u95a2\u4fc2\u3092\u7dad\u6301\u3059\u308b\u305f\u3081\u306bGP\u304c\u7528\u3044\u308b\u6226\u7565\u306e\u4e00\u3064\u306f\u3001\u8cac\u4efb\u3092\u30d7\u30e9\u30a4\u30de\u30ea\u30fb\u30b1\u30a2\u7d44\u7e54\u3084\u30ac\u30a4\u30c9\u30e9\u30a4\u30f3\u306a\u3069\u306e\u9060\u304f\u96e2\u308c\u305f\u7b2c\u4e09\u8005\u306b\u8ca0\u308f\u305b\u308b\u3053\u3068\u3067\u3042\u308b(28)\u3002\u3088\u3063\u3066\u3001\u30b2\u30fc\u30c8\u30ad\u30fc\u30d4\u30f3\u30b0\u306f\u3001\u500b\u3005\u306e\u81e8\u5e8a\u306e\u5834\u3067\u306f\u306a\u304f\u3001\u793e\u4f1a\u7684\u306a\u6587\u8108\u3067\u7406\u89e3\u3055\u308c\u308b\u3079\u304d\u3067\u3042\u308b\u3002
\n\u8fd1\u5e74\u3001\u533b\u7642\u306e\u904e\u5270\u4f7f\u7528\u306b\u5bfe\u51e6\u3059\u308b\u305f\u3081\u306e\u3055\u307e\u3056\u307e\u306a\u5c02\u9580\u7684\u306a\u53d6\u308a\u7d44\u307f\u304c\u56fd\u969b\u7684\u306b\u958b\u59cb\u3055\u308c\u3066\u3044\u307e\u3059\u304c(32.35)\u3001GP\u304c\u533b\u7642\u306e\u904e\u5270\u4f7f\u7528\u306b\u3088\u308b\u5bb3\u304b\u3089\u60a3\u8005\u3092\u5b88\u308b\u80fd\u529b\u3092\u652f\u63f4\u3059\u308b\u4e0a\u3067\u3001\u3053\u306e\u3088\u3046\u306a\u53d6\u308a\u7d44\u307f\u306e\u6709\u52b9\u6027\u306f\u307e\u3060\u8abf\u67fb\u3055\u308c\u3066\u3044\u306a\u3044\u305f\u3081\u3001\u66f4\u306a\u308b\u8abf\u67fb\u304c\u5f85\u305f\u308c\u308b\u3002<\/p>\n

Conclusion<\/strong>\uff1aGP\u304c\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u3068\u3057\u3066\u306e\u5f79\u5272\u3092\u7dad\u6301\u3059\u308b\u305f\u3081\u306b\u306f\u3001\u5c02\u9580\u7684\u306a\u30b3\u30df\u30e5\u30cb\u30b1\u30fc\u30b7\u30e7\u30f3\u30b9\u30ad\u30eb\u3068\u4eba\u9593\u95a2\u4fc2\u306e\u7d99\u7d9a\u6027\u304c\u512a\u5148\u3055\u308c\u308b\u5fc5\u8981\u304c\u3042\u308a\u307e\u3059\u3002\u3057\u304b\u3057\u3001theory of professions\u3067\u4e88\u6e2c\u3055\u308c\u308b\u3088\u3046\u306b\u3001\u30b2\u30fc\u30c8\u30ad\u30fc\u30d1\u30fc\u3068\u3057\u3066\u306e\u5f79\u5272\u306f\u3001\u533b\u7642\u5c02\u9580\u8077\u306e\u4e2d\u3060\u3051\u3067\u306a\u304f\u3001\u793e\u4f1a\u3084\u516c\u7684\u6a5f\u95a2\u304b\u3089\u306e\u30b5\u30dd\u30fc\u30c8\u304c\u5fc5\u8981\u3067\u3042\u308b\u3002<\/p>\n

\u3010\u958b\u50ac\u65e5\u3011
\n2021\u5e747\u67087\u65e5\uff08\u6c34\uff09<\/p>\n","protected":false},"excerpt":{"rendered":"

\u2015\u6587\u732e\u540d\u2015 J\u00f8rgen Breivold, Karin Isaksson R\u00f8, Stef\u00e1n Hj\u00f6rleifsson, Conditions for gatekeeping when GPs consider pa … \u7d9a\u304d\u3092\u8aad\u3080 \u5bb6\u5ead\u533b\u304c\u60a3\u8005\u304b\u3089\u306e\u8981\u6c42\u3092\u59a5\u5f53\u3067\u306f\u306a\u3044\u3068\u611f\u3058\u3001\u305d\u306e\u307e\u307e\u53d7\u3051\u5165\u308c\u308b\u306e\u3082\u3001\u62d2\u5426\u3059\u308b\u306e\u3082\u3044\u305a\u308c\u3082\u96e3\u3057\u3044\u6642\u306b\u3069\u3046\u5bfe\u5fdc\u3059\u308b\u304b -\u30d5\u30a9\u30fc\u30ab\u30b9\u30b0\u30eb\u30fc\u30d7\u7814\u7a76-<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7,23],"tags":[],"class_list":["post-2155","post","type-post","status-publish","format-standard","hentry","category-7","category-23"],"_links":{"self":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2155","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=2155"}],"version-history":[{"count":1,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2155\/revisions"}],"predecessor-version":[{"id":2156,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=\/wp\/v2\/posts\/2155\/revisions\/2156"}],"wp:attachment":[{"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=2155"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=2155"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.hcfm.jp\/journal\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=2155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}