Thomas R E, Grimshaw J M, Mollison J, McClinton S, McIntosh E, Deans H, Repper J
Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK.
Fam Pract. 2003 Dec;20(6):646-54. doi: 10.1093/fampra/cmg605.
Out-patient services are trying to achieve effective and efficient health care in overcrowded, busy clinic settings. "One stop" and "open access" clinics have been advocated as a way of improving out-patient services.
Our aim was to evaluate the effectiveness and efficiency of a guideline-based open access urological investigation service.
General practices were randomized to receive either referral guidelines and access to the investigation service for lower urinary tract symptoms (LUTS) or referral guidelines and access to the investigation service for microscopic haematuria (MH). The study population comprised 66 general practices in the Grampian region of Scotland referring 959 patients. The outcome measures were compliance with guidelines (number of recommended investigations completed), number of general practice consultations, the number and case mix of referrals, waiting time to initial hospital appointment, and the number of patients with a management decision reached at initial appointment and discharged by 12 months after referral.
GPs' compliance with referral guidelines increased (difference in means 0.5; 95% confidence interval 0.2-0.8, P < 0.001). Approximately 50% of eligible patients were referred through the new system. The number and case mix of referrals were similar. The intervention reduced the waiting time from referral to initial out-patient appointment (ratio of means 0.7; 0.5-0.9, patients with LUTS only) and increased the number of patients who had a management decision reached at initial appointment (odds ratio 5.8; 2.9-11.5, P < 0.00001, both conditions). Patients were more likely to be discharged within 12 months (odds ratio 1.7; 0.9-3.3, P = 0.11). There were no significant changes detected in patient outcomes. Overall the new service was probably cost saving to the NHS.
The guideline-based open access investigation service streamlined the process of out-patient referral, resulting in a more efficient service with reduced out-patient waiting times, fewer out-patient and investigation appointments and release of specialist and clinic time.
门诊服务试图在拥挤、繁忙的诊所环境中实现高效的医疗保健。“一站式”和“开放式就诊”诊所被倡导为改善门诊服务的一种方式。
我们的目的是评估基于指南的开放式泌尿外科检查服务的有效性和效率。
将全科诊所随机分为两组，一组接受下尿路症状（LUTS）转诊指南并可使用检查服务，另一组接受显微镜下血尿（MH）转诊指南并可使用检查服务。研究人群包括苏格兰格兰扁地区的66家全科诊所转诊的959名患者。结果指标包括对指南的依从性（完成推荐检查的数量）、全科诊所咨询次数、转诊数量和病例组合、首次医院预约的等待时间，以及在首次预约时做出管理决策并在转诊后12个月内出院的患者数量。
全科医生对转诊指南的依从性有所提高（均值差异为0.5；95%置信区间为0.2 - 0.8，P < 0.001）。约50%的符合条件患者通过新系统转诊。转诊数量和病例组合相似。干预措施缩短了从转诊到首次门诊预约的等待时间（仅LUTS患者的均值比为0.7；0.5 - 0.9），并增加了在首次预约时做出管理决策的患者数量（优势比为5.8；2.9 - 11.5，P < 0.00001，两种情况均如此）。患者在12个月内出院的可能性更大（优势比为1.7；0.9 - 3.3，P = 0.11）。未发现患者结局有显著变化。总体而言，新服务可能为英国国家医疗服务体系节省了成本。
基于指南的开放式检查服务简化了门诊转诊流程，带来了更高效的服务，减少了门诊等待时间、门诊和检查预约次数，并释放了专科医生和诊所的时间。
