Scott Anthony, Watson M Stuart, Ross Sue
Health Economics Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 9ZD, UK.
Soc Sci Med. 2003 Feb;56(4):803-14. doi: 10.1016/s0277-9536(02)00079-5.
Access to primary care services is a major issue as new models of delivering primary care continue develop in many countries. Major changes to out of hours care provided by general practitioners (GPs) were made in the UK in 1995. These were designed in response to low morale and job dissatisfaction of GPs, rather than in response to patients' preferences. The aim of this study is to elicit the preferences of patients and the community for different models of GP out of hours care. A questionnaire was sent to parents of children in Aberdeen and Glasgow in Scotland who had received a home visit or attended a primary care emergency centre, or were registered with a GP. The questionnaire used a discrete choice experiment that asked parents to imagine their child had respiratory symptoms. Parents were then asked to choose between a series of pairs of scenarios, with each scenario describing a different model of out of hours care. Each model varied by waiting time, who was seen, location, and whether the doctor listened. The response rate was 68% (3,893/5,718). The most important attribute was whether the doctor seemed to listen, suggesting that policies aimed at improving doctor-patient communication will lead to the largest improvements in utility. The most preferred location of care was a hospital accident and emergency department. This suggests that new models of primary care emergency centres may not reduce the demand for accident and emergency visits from this group of patients in urban areas. Preferences also differed across sub-groups of patients. Those who had never used out of hours care before had stronger preferences for waiting time and the doctor listening, suggesting higher expectations of non-users. Further research is required into the demand for out of hours care as new models of care become established.
随着许多国家不断发展初级医疗服务的新模式，获得初级医疗服务成为一个主要问题。1995年英国对全科医生（GP）提供的非工作时间医疗服务进行了重大改革。这些改革是针对全科医生士气低落和工作不满而做出的，而非根据患者的偏好。本研究的目的是了解患者和社区对不同模式的全科医生非工作时间医疗服务的偏好。向苏格兰阿伯丁和格拉斯哥的儿童家长发放了问卷，这些家长曾接受过家访或去过初级医疗急救中心，或在全科医生处登记。问卷采用离散选择实验，要求家长想象他们的孩子有呼吸道症状。然后要求家长在一系列情景对中进行选择，每个情景描述一种不同的非工作时间医疗服务模式。每种模式在等待时间、看病对象、地点以及医生是否倾听方面有所不同。回复率为68%（3893/5718）。最重要的属性是医生是否看起来在倾听，这表明旨在改善医患沟通的政策将带来最大的效用提升。最受欢迎的看病地点是医院急诊科。这表明初级医疗急救中心的新模式可能无法减少城市地区这类患者对急诊就诊的需求。不同亚组患者的偏好也存在差异。那些以前从未使用过非工作时间医疗服务的人对等待时间和医生倾听有更强的偏好，表明非使用者有更高的期望。随着新的医疗模式确立，需要对非工作时间医疗服务的需求进行进一步研究。
