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国民保健服务(NHS)随诊中心对当地初级医疗服务的影响:前后对照观察性研究

Effect of NHS walk-in centre on local primary healthcare services: before and after observational study.

作者信息

Hsu Ronald T, Lambert Paul C, Dixon-Woods Mary, Kurinczuk Jennifer J

机构信息

Department of Epidemiology and Public Health, University of Leicester, Leicester LE1 6TP.

出版信息

BMJ. 2003 Mar 8;326(7388):530. doi: 10.1136/bmj.326.7388.530.

Abstract

OBJECTIVE

To assess the effect of an NHS walk-in centre on local primary and emergency healthcare services.

DESIGN

Before and after observational study.

SETTING

Loughborough, which had an NHS walk-in centre, and Market Harborough, the control town.

PARTICIPANTS

12 general practices.

MAIN OUTCOME MEASURES

Mean daily rate of emergency general practitioner consultations, mean number of half days to the sixth bookable routine appointment, and attendance rates at out of hours services, minor injuries units, and accident and emergency departments.

RESULTS

The change between the before and after study periods was not significantly different in the two towns for daily rate of emergency general practice consultations (mean difference -0.02/1000 population, 95% confidence interval -0.75 to 0.71), the time to the sixth bookable routine appointment (-0.24 half-days, -1.85 to 1.37), and daily rate of attendances at out of hours services (0.07/1000 population, -0.06 to 0.19). However, attendance at the local minor injuries unit was significantly higher in Loughborough than Market Harborough (rate ratio 1.22, 1.12 to 1.33). Non-ambulance attendances at accident and emergency departments fell less in Loughborough than Market Harborough (rate ratio 1.17, 1.03 to 1.33).

CONCLUSIONS

The NHS walk-in centre did not greatly affect the workload of local general practitioners. However, the workload of the local minor injuries unit increased significantly, probably because it was in the same building as the walk-in centre.

摘要

目的

评估国民保健服务(NHS)的随诊中心对当地初级和急诊医疗服务的影响。

设计

前后观察性研究。

地点

设有NHS随诊中心的拉夫堡以及作为对照城镇的哈伯勒镇。

参与者

12家普通诊所。

主要观察指标

急诊全科医生每日平均会诊率、到第六次可预约常规预约的平均半天数,以及非工作时间服务、轻伤单位和急诊科的就诊率。

结果

在两个城镇中,研究前后期间的变化在急诊全科医生每日会诊率(平均差异-0.02/1000人口,95%置信区间-0.75至0.71)、到第六次可预约常规预约的时间(-0.24半天,-1.85至1.37)以及非工作时间服务的每日就诊率(0.07/1000人口,-0.06至0.19)方面无显著差异。然而,拉夫堡当地轻伤单位的就诊率显著高于哈伯勒镇(率比1.22,1.12至1.33)。拉夫堡急诊科的非救护车就诊量下降幅度小于哈伯勒镇(率比1.17,1.03至1.33)。

结论

NHS随诊中心对当地全科医生的工作量影响不大。然而,当地轻伤单位的工作量显著增加,可能是因为它与随诊中心在同一栋楼内。

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