Gallagher M, Pearson P, Drinkwater C, Guy J
Department of Primary Care, University of Newcastle upon Tyne.
Br J Gen Pract. 2001 Apr;51(465):280-5.
Managing patients' requests for appointments is an important general practice activity. No previous research has systematically observed how patients and receptionists negotiate appointments.
To observe appointment making and investigate patients' and professionals' experiences of appointment negotiations.
A qualitative study using participant observation.
Three general practices on Tyneside; a single-handed practice, a practice comprising three doctors, and a seven-doctor practice.
Participant observation sessions, consisting of 35 activity recordings and 34 periods of observation and 38 patient and 15 professional interviews, were set up. Seven groups of patients were selected for interview. These included patients attending an 'open access' surgery, patients who complained about making an appointment, and patients who complimented the receptionists.
Appointment making is a complex social process. Outcomes are dependent on the process of negotiation and factors, such as patients' expectations and appointment availability. Receptionists felt that patients in employment, patients allocated to the practice by the Health Authority, and patients who did not comply with practice appointment rules were most demanding. Appointment requests are legitimised by receptionists enforcing practice rules and requesting clinical information. Patients volunteer information to provide evidence that their complaint is appropriate and employ strategies, such as persistence, assertiveness, and threats, to try and persuade receptionists to grant appointments.
Appointment making is a complex social process where outcomes are negotiated. Receptionists have an important role in managing patient demand. Practices should be explicit about how appointments are allocated, including publishing practice criteria.
处理患者的预约请求是一项重要的全科医疗活动。此前尚无研究系统观察患者与接待员如何协商预约事宜。
观察预约安排过程，并调查患者和专业人员在预约协商中的体验。
采用参与观察法的定性研究。
泰恩赛德的三家全科诊所；一家单人执业诊所、一家有三名医生的诊所和一家有七名医生的诊所。
开展参与观察活动，包括35次活动记录、34次观察时段以及38次患者访谈和15次专业人员访谈。选取七组患者进行访谈。其中包括前往“开放式预约”门诊的患者、抱怨预约困难的患者以及称赞接待员的患者。
预约安排是一个复杂的社会过程。结果取决于协商过程以及患者期望和预约可获得性等因素。接待员认为在职患者、由卫生当局分配到该诊所的患者以及不遵守诊所预约规定的患者要求最高。接待员通过执行诊所规定并要求提供临床信息，使预约请求合法化。患者主动提供信息以证明其诉求合理，并采用坚持、坚定和威胁等策略，试图说服接待员批准预约。
预约安排是一个结果需协商的复杂社会过程。接待员在管理患者需求方面发挥着重要作用。诊所应明确说明预约如何分配，包括公布诊所标准。
