Rogers A, Kennedy A, Nelson E, Robinson A
National Primary Care Research and Development Centre, The University of Manchester, Manchester M13 9PL, UK.
Qual Saf Health Care. 2004 Oct;13(5):374-8. doi: 10.1136/qhc.13.5.374.
Improving access is a key policy issue in improving quality of care and extending patient choice and participation. People's experience of changing from fixed outpatient appointments to more flexible direct access arrangements for chronic disease has been underexplored.
To examine patients' views on using an open system of access compared with fixed outpatient appointments as part of a guided self-management intervention for inflammatory bowel disease (IBD).
Embedded qualitative study undertaken alongside a randomised controlled trial. Semi-structured interviews were undertaken to obtain an in depth understanding of patients' experience of the change in access arrangements.
A purposive sample (n = 30) was drawn from the intervention group (n = 700) according to a range of responses to the trial baseline and follow up quantitative measures.
28 interviews were included in the analysis. Compared with the previous system of fixed appointments, preference for the new open access system was based on enhanced personal control in contacting services and the view that it fitted better with everyday routine management and the requirement for urgent medical contact when symptoms fail to respond to medication. Preference for retaining fixed appointments was based on a sense of security from gaining access which did not require the individual to initiate the request for medical help.
Open access may fit better with patients' self-management of their condition and everyday routines, roles and responsibilities. Ensuring that outpatient organisational arrangements and personnel are responsive to patient initiated requests for appointments is likely to impact on the acceptability of this type of access arrangement. Some people may continue to prefer the fixed appointment system which should be retained if patient choice is to be respected.
改善医疗服务可及性是提高医疗质量、扩大患者选择范围和参与度的关键政策问题。对于慢性病患者从固定门诊预约转向更灵活的直接就诊安排的体验，人们尚未进行充分研究。
探讨与固定门诊预约相比，患者对采用开放式就诊系统作为炎症性肠病（IBD）自我管理干预措施一部分的看法。
在一项随机对照试验的基础上进行嵌入式定性研究。通过半结构化访谈深入了解患者对就诊安排变化的体验。
根据对试验基线和随访定量测量的一系列反应，从干预组（n = 700）中选取了一个有目的的样本（n = 30）。
28次访谈纳入分析。与先前的固定预约系统相比，对新的开放式就诊系统的偏好基于在联系服务方面增强的个人控制权，以及认为它更符合日常常规管理以及症状对药物无反应时紧急医疗联系的需求。对保留固定预约的偏好基于获得就诊带来的安全感，这种方式无需个人主动寻求医疗帮助。
开放式就诊可能更符合患者对自身病情的自我管理以及日常事务、角色和责任。确保门诊组织安排和工作人员能够响应患者主动提出的预约请求，可能会影响这种就诊安排的可接受性。有些人可能仍然更喜欢固定预约系统，如果要尊重患者选择，就应该保留该系统。
