McLeod Deborah, Morgan Sonya, McKinlay Eileen, Dew Kevin, Cumming Jackie, Dowell Anthony, Love Tom
Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
J Health Serv Res Policy. 2004 Apr;9(2):91-9. doi: 10.1258/135581904322987508.
To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery.
A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed. Data were analysed by a process of thematic analysis.
Sixty-five interviews were completed. General practitioners had a key role in determining which patients were seen in the public sector and, by utilising strategies to actively advocate for patients, influenced both waiting times for first assessment by surgeons and for surgery. CPAC had been developed as decision support guides with the intention that they would provide transparency and equity in determining access. However, there was variation in the way CPAC were being used both in score construction and in the influence of the score on access to surgery. The management of the hospital system also limited the extent to which CPAC could be used to prioritise patients for surgery.
Variability in the use of CPAC tools meant that at the time of the study they did not provide a transparent and equitable method of determining access to surgery. This highlights the difficulties in developing and implementing CPAC and suggests that further development is difficult in the absence of evidence to identify patients who will benefit the most from surgery.
描述新西兰患者获得择期手术的方式，并了解临床优先评估标准（CPAC）在确定获得公共资助的择期手术资格时的使用情况及态度。
在新西兰选定地区进行的一项定性研究。对公立医院的全科医生、外科医生和管理人员进行了有目的抽样访谈。通过主题分析过程对数据进行分析。
完成了65次访谈。全科医生在确定哪些患者在公共部门接受治疗方面发挥着关键作用，并且通过采取积极为患者争取权益的策略，影响了患者接受外科医生首次评估和手术的等待时间。CPAC已被开发为决策支持指南，旨在为确定手术资格提供透明度和公平性。然而，CPAC在评分构建以及评分对手术资格的影响方面的使用方式存在差异。医院系统的管理也限制了CPAC用于确定患者手术优先级的程度。
CPAC工具使用的变异性意味着在研究时，它们并未提供一种透明且公平的确定手术资格的方法。这凸显了开发和实施CPAC的困难，并表明在缺乏证据来确定哪些患者将从手术中获益最大的情况下，进一步的开发工作会很困难。
