Rubin Greg, Bate Angela, George Ajay, Shackley Phil, Hall Nicola
Centre for Primary and Community Care, University of Sunderland, Green Terrace, Sunderland SR1 3PZ.
Br J Gen Pract. 2006 Oct;56(531):743-8.
Access to primary care services is one of the key components of the NHS Plan which states that patients should be able to see a health professional within 24 hours and a GP within 48 hours. However, it is not clear how patients value speed of access in comparison with other aspects of primary care.
To investigate patient preferences when making an routine appointment for a GP, and to describe the trade-offs and relationships between speed of access, choice of time and choice of doctor in different patient groups.
Discrete choice experiment.
Adults consulting a GP in six general practices in Sunderland.
Choice sets based on three attributes (time to appointment, choice of time, choice of doctor) were presented in a self-completion questionnaire.
We obtained 6985 observations from 1153 patients. We found that the waiting time to make an appointment was only important if the appointment is for a child or when attending for a new health problem. Other responders would trade-off a shorter waiting time and be willing to wait in order to either see their own choice of doctor or attend an appointment at their own choice of time. For responders who work, choice of time is six times more important than a shorter waiting time and they are willing to wait up to 1 day extra for this. Those with a long-standing illness value seeing their own GP more than seven times as much as having a shorter waiting time for an appointment and will wait an extra 1 day for an appointment with the GP of their choice, women will wait an extra 2 days, and older patients an extra 2.5 days.
Speed of access is of limited importance to patients accessing their GP, and for many is outweighed by choice of GP or convenience of appointment.
获得初级医疗服务是《国民保健服务计划》的关键组成部分之一，该计划规定患者应能在24小时内见到医疗专业人员，48小时内见到全科医生。然而，与初级医疗的其他方面相比，患者如何看待就诊速度尚不清楚。
调查患者在预约全科医生常规就诊时的偏好，并描述不同患者群体在就诊速度、就诊时间选择和医生选择之间的权衡与关系。
离散选择实验。
在桑德兰的六个全科诊所咨询全科医生的成年人。
在一份自填式问卷中呈现基于三个属性（预约时间、就诊时间选择、医生选择）的选择集。
我们从1153名患者那里获得了6985份观察结果。我们发现，只有当预约对象是儿童或因新的健康问题就诊时，预约等待时间才重要。其他受访者会权衡较短的等待时间，并愿意等待，以便能看自己选择的医生或在自己选择的时间就诊。对于有工作的受访者来说，就诊时间的选择比缩短等待时间重要六倍，他们愿意为此多等1天。患有长期疾病的患者看重看自己的全科医生的程度是缩短预约等待时间的七倍多，并且会为了预约自己选择的全科医生多等1天，女性会多等2天，老年患者会多等2.5天。
就诊速度对预约全科医生的患者来说重要性有限，对许多人来说，全科医生的选择或预约的便利性比就诊速度更重要。
