Salisbury Chris, Munro James
Division of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol BS6 6JL.
Br J Gen Pract. 2003 Jan;53(486):53-9.
Nurse-led walk-in centres were first announced in April 1999. They represent a new development in unscheduled care provision in the United Kingdom (UK) National Health Service (NHS). By the end of 2000, 40 NHS walk-in centres had been opened, with further centres recently announced. This paper aims to review international experience with walk-in centres in primary and emergency care and identify relevant lessons for the UK. This study is a systematic review, with qualitative synthesis of relevant findings. Studies were identified from seven major bibliographic databases using a sensitive search strategy, and 244 relevant documents relating to walk-in or 'ambulatory care' centres were identified. Users of walk-in centres in other countries tend to be a relatively affluent population of working age, and a different population from those using conventional general practice services. Walk-in centres are used particularly when other health services are closed. The problems presented are mainly minor illnesses and minor injuries. People choose this form of care mainly for reasons of convenience, and satisfaction with the service is generally high. The very limited evidence available suggests that walk-in centres provide care of reasonable quality, but there is insufficient evidence to draw firm conclusions about the impact of walk-in centres on other healthcare services or the costs of such care. Although a number of countries have had a long experience of walk-in centres, the lack of reliable evidence on many of the most important issues is notable. In the NHS, walk-in centres represent a radically innovative attempt to improve access to health care, but the limited research available does little to inform their development. Important questions that need to be addressed include whether walk-in centres do improve access to care, for whom, and at what overall cost.
由护士主导的随到随诊中心于1999年4月首次宣布设立。它们代表了英国国民医疗服务体系（NHS）中临时医疗服务提供方面的一项新发展。到2000年底，已开设了40家NHS随到随诊中心，近期还宣布将开设更多中心。本文旨在回顾随到随诊中心在初级和急诊护理方面的国际经验，并为英国找出相关经验教训。本研究是一项系统综述，对相关研究结果进行定性综合分析。使用灵敏的检索策略从七个主要文献数据库中识别出研究，共识别出244份与随到随诊或“门诊护理”中心相关的文献。其他国家随到随诊中心的使用者往往是相对富裕的工作年龄人群，与使用传统全科医疗服务的人群不同。人们尤其在其他医疗服务机构关门时使用随到随诊中心。前来就诊的问题主要是小病和轻伤。人们选择这种护理形式主要是出于方便的原因，并且对服务的满意度普遍较高。现有的非常有限的证据表明随到随诊中心提供的护理质量合理，但没有足够的证据就随到随诊中心对其他医疗服务的影响或此类护理的成本得出确凿结论。尽管一些国家在随到随诊中心方面有长期经验，但在许多最重要的问题上缺乏可靠证据是值得注意的。在NHS中，随到随诊中心是改善医疗服务可及性的一项极具创新性的尝试，但现有的有限研究对其发展的指导作用不大。需要解决的重要问题包括随到随诊中心是否真的改善了医疗服务可及性、对哪些人有改善以及总体成本是多少。
