Dunt David, Day Susan E, Kelaher Margaret, Montalto Michael
Program Evaluation Unit, School of Population Health, University of Melbourne, Victoria, Australia.
Fam Pract. 2006 Aug;23(4):453-60. doi: 10.1093/fampra/cml020. Epub 2006 May 15.
The After Hours Primary Medical Trials were initiated by the Australian government to redress difficulties in after hours (AH) GP care in areas of high need. The study's objective is to study the impact of two standalone call centres and one GP cooperative offering comprehensive services, in improving consumer access to services for residents of a defined geographic area.
A pre-post design was used to evaluate their impact after adjusting for secular trend at a national level. Access was considered in terms of availability, accessibility, affordability, acceptability and responsiveness of care. Unmet need and ease of obtaining AH telephone professional medical advice were also considered. Pre-trial and post-trial telephone surveys of two separate random samples of approximately 350 households using AH services in each trial area as well as in a national sample outside the trial areas.
Consumer acceptability and affordability increased in residents in the area served by the GP cooperative. Access, however measured, did not improve in either of the standalone call centre areas. Reduction in unmet need approached but did not achieve statistical significance in most but not all trial areas.
Improvements in access in the GP cooperative conformed to expectations based on current and pre-existing AH care arrangements put in place. Absence of improvements in access in the standalone call centres did not conform to expectations but may be partly explained by the reductions in consumer acceptability, following introduction of telephone triage systems reported elsewhere.
非工作时间初级医疗试验由澳大利亚政府发起，旨在解决高需求地区非工作时间全科医生护理方面的困难。该研究的目的是研究两个独立呼叫中心和一个提供综合服务的全科医生合作社对改善特定地理区域居民获得服务的影响。
采用前后设计，在调整全国范围内的长期趋势后评估其影响。从护理的可及性、可达性、可负担性、可接受性和响应性方面考虑获得服务的情况。还考虑了未满足的需求以及获得非工作时间电话专业医疗建议的难易程度。对每个试验区域以及试验区域外的全国样本中使用非工作时间服务的两个约350户家庭的独立随机样本进行试验前和试验后的电话调查。
在全科医生合作社服务区域的居民中，消费者的可接受性和可负担性有所提高。然而，在任何一个独立呼叫中心区域，无论如何衡量，获得服务的情况都没有改善。在大多数但并非所有试验区域，未满足需求的减少接近但未达到统计学显著性。
全科医生合作社在获得服务方面的改善符合基于当前和先前实施的非工作时间护理安排的预期。独立呼叫中心在获得服务方面没有改善不符合预期，但可能部分是由于其他地方报告的引入电话分诊系统后消费者可接受性的降低。
