Pickin D M, O'Cathain A, Fall M, Morgan A B, Howe A, Nicholl J P
Medical Care Research Unit, Sheffield Health Economics Group and Institute of General Practice and Primary Care, School of Health and Related Research, University of Sheffield, Sheffield S1 4DA, UK.
Fam Pract. 2004 Apr;21(2):180-2. doi: 10.1093/fampra/cmh213.
The advent of general practice co-operatives represented a fundamental change in the delivery and organization of out-of-hours services. Concerns have been voiced that co-operatives might impact adversely on workload in accident and emergency (A&E) departments.
The purpose of this study was to assess the impact of establishing a general practice co-operative on use of A&E services, patient satisfaction and GP satisfaction.
A controlled before and after study of a GP co-operative in Sheffield, UK was carried out. A postal questionnaire was sent to 26 911 people, 13 442 before and 13 469 after the opening of the co-operative, to determine service use, in particular A&E attendance, in the previous 4 weeks. Patient satisfaction was assessed through structured interviews with 653 patients. GP satisfaction was assessed using a postal survey of all 98 Sheffield practices 2 years after the opening of the co-operative.
There was no change in the use of A&E services, odds ratio = 1.08 (95% confidence interval 0.60-1.94). There was no change in patient satisfaction overall, mean difference 0.02 (-0.32 to 0.36). Sixty-seven per cent of doctors in member practices were much more satisfied with out-of-hours duty compared with 10% in non-member practices (P < 0.001).
General practice co-operatives have been successful in achieving their policy objectives, improving GP morale without jeopardizing patient satisfaction or impacting adversely on A&E services.
全科医疗合作社的出现代表了非工作时间服务提供和组织方面的根本性变革。有人担心合作社可能会对急诊（A&E）部门的工作量产生不利影响。
本研究的目的是评估建立全科医疗合作社对A&E服务使用、患者满意度和全科医生满意度的影响。
对英国谢菲尔德的一个全科医生合作社进行了一项前后对照研究。向26911人发送了邮政问卷，合作社开业前13442人，开业后13469人，以确定前4周的服务使用情况，特别是A&E就诊情况。通过对653名患者进行结构化访谈来评估患者满意度。在合作社开业2年后，通过对谢菲尔德所有98家诊所进行邮政调查来评估全科医生满意度。
A&E服务的使用没有变化，优势比=1.08（95%置信区间0.60 - 1.94）。总体患者满意度没有变化，平均差异为0.02（-0.32至0.36）。成员诊所中67%的医生对非工作时间值班的满意度更高，而非成员诊所中这一比例为10%（P < 0.001）。
全科医疗合作社成功实现了其政策目标，提高了全科医生的士气，同时不影响患者满意度，也不对A&E服务产生不利影响。
