Corney R H
University of Greenwich, London.
Br J Gen Pract. 1999 Jan;49(438):27-30.
The contributions of patients' opinions to the evaluation of health care is widely acknowledged. This study investigates whether the patients of a fundholding practice perceived any changes in the services offered.
To examine the effect of general practice fundholding on patient satisfaction with both primary and secondary care services.
In April 1992, questionnaires were sent to 180 patients in each of four second-wave fundholding practices and four non-fundholding practices in the former South East Thames region. This took place before any changes were made in the practices as a result of fundholding. Repeat questionnaires were sent 30 months later.
The overall response rate was 70% in 1992 and 66% in 1994/1995. Satisfaction levels were generally high for primary care services and changed little over time. There was no evidence to suggest that fundholding GPs were less inclined to prescribe or refer to secondary care services. Waiting times for the first appointment with a consultant in secondary care had reduced between 1992 and 1994 for patients referred from the fundholding practices. However, there were no differences in the time patients had to wait for subsequent treatments or further investigations. One-fifth of the fundholding patients referred to secondary care were seen by the specialist in their doctor's surgery, and those seen in this setting preferred it.
Patients perceived no major differences in primary care services over the period between the two surveys. There was some evidence of preferential treatment for patients of fundholding practices, but only in waiting times for the first appointment with the secondary care specialist.
患者意见对医疗保健评估的贡献已得到广泛认可。本研究调查了实行基金持有制的医疗机构的患者是否察觉到所提供服务的任何变化。
研究全科医疗基金持有制对患者对初级和二级医疗服务满意度的影响。
1992年4月，向前东南泰晤士地区的四家第二轮实行基金持有制的医疗机构和四家非基金持有制医疗机构中的每家机构的180名患者发放问卷。这是在因基金持有制而对医疗机构做出任何改变之前进行的。30个月后再次发放问卷。
1992年的总体回复率为70%，1994/1995年为66%。患者对初级医疗服务的满意度普遍较高，且随时间变化不大。没有证据表明实行基金持有制的全科医生不太愿意开处方或转诊至二级医疗服务机构。1992年至1994年期间，从实行基金持有制的医疗机构转诊的患者首次预约二级医疗顾问的等待时间有所缩短。然而，患者等待后续治疗或进一步检查的时间没有差异。转诊至二级医疗的基金持有制患者中有五分之一在其医生的诊所接受了专科医生的诊治，在这种环境下接受诊治的患者更喜欢这种方式。
在两次调查期间，患者认为初级医疗服务没有重大差异。有证据表明实行基金持有制的医疗机构的患者得到了优先治疗，但仅体现在首次预约二级医疗专科医生的等待时间上。
