Carlisle R, Johnstone S
Department of General Practice, University of Nottingham, University Hospital Nottingham.
Br J Gen Pract. 1998 Oct;48(435):1675-8.
The relationship between socio-economic factors and consultation rates is important in determining resource allocation to general practices.
To determine the relationship between general practice surgery consultation rates and census-derived socio-economic variables for patients receiving the same primary and secondary care.
A retrospective analysis was taken of computerized records in three general practices in Mansfield, North Nottinghamshire, with 29,142 patients spread over 15 electoral wards (Jarman score range from -23 to +25.5). Linear regression analysis of surgery consultation rates at ward and enumeration district levels was performed against Jarman and Townsend deprivation scores and census socio-economic variables.
Both the Townsend score (r2 = 59%) and the Jarman score (r2 = 39%) were associated with surgery consultation rates at ward level. The Townsend score had a stronger association than the Jarman score because all four of its component variables were individually associated with increased consultations compared with four out of eight Jarman components.
Even in practices not eligible for deprivation payments there were appreciable differences in consultation rates between areas with different socio-economic characteristics. The results suggest that the variables used to determine deprivation payments should be reconsidered, and they support suggestions that payments should be introduced at a lower level of deprivation and administered on an enumeration district basis.
社会经济因素与诊疗率之间的关系对于确定全科医疗资源分配至关重要。
确定接受相同初级和二级医疗服务的患者的全科医疗诊疗率与基于人口普查得出的社会经济变量之间的关系。
对北诺丁汉郡曼斯菲尔德的三家全科医疗诊所的计算机记录进行回顾性分析,29142名患者分布在15个选区(贾曼评分范围为-23至+25.5)。针对贾曼和汤森贫困评分以及人口普查社会经济变量,在选区和枚举区层面进行了手术诊疗率的线性回归分析。
汤森评分(r2 = 59%)和贾曼评分(r2 = 39%)均与选区层面的手术诊疗率相关。汤森评分的关联比贾曼评分更强,因为其所有四个组成变量与诊疗增加均单独相关,而贾曼评分的八个组成变量中只有四个如此。
即使在不符合贫困补贴条件的诊所中,具有不同社会经济特征的地区之间的诊疗率也存在明显差异。结果表明,应重新考虑用于确定贫困补贴的变量,并且支持在较低贫困水平引入补贴并按枚举区进行管理的建议。