Hutchison Brian, Østbye Truls, Barnsley Jan, Stewart Moira, Mathews Maria, Campbell M Karen, Vayda Eugene, Harris Stewart B, Torrance-Rynard Vicki, Tyrrell Christine
Department of Family Medicine, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ont.
CMAJ. 2003 Apr 15;168(8):977-83.
Although walk-in clinics are an increasingly common feature of Ontario's health care system, the quality of care they provide is the subject of continuing debate. In this study we examined differences in patient satisfaction and quality of care for common acute conditions in walk-in clinics, family practices and emergency departments.
For this prospective cohort study, we recruited 12 walk-in clinics, 16 family practices and 13 emergency departments from 11 geographic areas in greater Toronto, Hamilton-Burlington and London, Ont. An expert review panel selected and established quality-of-care criteria for 8 common acute conditions. Patients who sought initial care for 1 of the 8 conditions were recruited by an on-site data collector. We used a questionnaire to assess the satisfaction of 433 patients with patient-centred communication, the physician's attitude and any delay in the waiting room during the study visit. Abstractors reviewed 600 charts for the study patients to assess whether the quality-of-care criteria had been met. A quality score for each case was computed as the percentage of applicable criteria that were met. Mean quality scores for the 3 settings were computed, with adjustment for potentially confounding variables (sex, age, city and diagnosis).
After adjustment for 12 patient characteristics, walk-in clinic patients were significantly more satisfied than emergency department patients on all 3 satisfaction scales. Family practice patients were more satisfied than walk-in clinic patients on all 3 satisfaction scales, but the difference was statistically significant only for satisfaction with waiting time. Adjusted mean quality-of-care scores were 73.1% for emergency departments, 69.9% for walk-in clinics and 64.1% for family practices. The scores for walk-in clinics and emergency departments were significantly higher than that for family practices.
Satisfaction with waiting time was highest among family practice patients. Both family practices and walk-in clinics were perceived more positively than emergency departments on all 3 dimensions of satisfaction. Overall quality-of-care scores were higher in walk-in clinics and emergency departments than in family practices.
尽管无需预约的诊所是安大略省医疗保健系统中日益常见的特色，但它们所提供的医疗服务质量一直是持续争论的话题。在本研究中，我们调查了无需预约的诊所、家庭医生诊所和急诊科在常见急性病症患者满意度和医疗服务质量方面的差异。
在这项前瞻性队列研究中，我们从大多伦多地区、汉密尔顿 - 伯灵顿地区和安大略省伦敦市的11个地理区域招募了12家无需预约的诊所、16家家庭医生诊所和13家急诊科。一个专家评审小组为8种常见急性病症选定并制定了医疗服务质量标准。现场数据收集人员招募了因这8种病症之一寻求初始治疗的患者。我们使用一份问卷来评估433名患者对以患者为中心的沟通、医生态度以及在此次就诊期间候诊室等待时间的满意度。摘要撰写人员查阅了600份研究患者的病历，以评估医疗服务质量标准是否得到满足。每个病例的质量得分计算为所满足的适用标准的百分比。计算了这三种医疗机构的平均质量得分，并对潜在的混杂变量（性别、年龄、城市和诊断）进行了调整。
在对12项患者特征进行调整后，无需预约的诊所患者在所有3项满意度量表上的满意度均显著高于急诊科患者。家庭医生诊所患者在所有3项满意度量表上的满意度均高于无需预约的诊所患者，但仅在等待时间满意度方面差异具有统计学意义。调整后的平均医疗服务质量得分分别为：急诊科73.1%，无需预约的诊所69.9%以及家庭医生诊所64.1%。无需预约的诊所和急诊科的得分显著高于家庭医生诊所。
家庭医生诊所患者对等待时间的满意度最高。在所有3个满意度维度上，家庭医生诊所和无需预约的诊所都比急诊科得到更积极的评价。无需预约的诊所和急诊科的总体医疗服务质量得分高于家庭医生诊所。
