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全科医疗合作社:距离远导致家访等待时间长?

General practice cooperatives: long waiting times for home visits due to long distances?

作者信息

Giesen Paul, van Lin Nieke, Mokkink Henk, van den Bosch Wil, Grol Richard

机构信息

Centre for Quality of Care Research (WOK), Radboud University Nijmegen Medical Centre, KWAZO 114, Nijmegen, The Netherlands.

出版信息

BMC Health Serv Res. 2007 Feb 12;7:19. doi: 10.1186/1472-6963-7-19.


DOI:10.1186/1472-6963-7-19
PMID:17295925
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1804268/
Abstract

BACKGROUND: The introduction of large-scale out-of-hours GP cooperatives has led to questions about increased distances between the GP cooperatives and the homes of patients and the increasing waiting times for home visits in urgent cases. We studied the relationship between the patient's waiting time for a home visit and the distance to the GP cooperative. Further, we investigated if other factors (traffic intensity, home visit intensity, time of day, and degree of urgency) influenced waiting times. METHODS: Cross-sectional study at four GP cooperatives. We used variance analysis to calculate waiting times for various categories of traffic intensity, home visit intensity, time of day, and degree of urgency. We used multiple logistic regression analysis to calculate to what degree these factors affected the ability to meet targets in urgent cases. RESULTS: The average waiting time for 5827 consultations was 30.5 min. Traffic intensity, home visit intensity, time of day and urgency of the complaint all seemed to affect waiting times significantly. A total of 88.7% of all patients were seen within 1 hour. In the case of life-threatening complaints (U1), 68.8% of the patients were seen within 15 min, and 95.6% of those with acute complaints (U2) were seen within 1 hour. For patients with life-threatening complaints (U1) the percentage of visits that met the time target of 15 minutes decreased from 86.5% (less than 2.5 km) to 16.7% (equals or more than 20 km). DISCUSSION AND CONCLUSION: Although home visits waiting times increase with increasing distance from the GP cooperative, it appears that traffic intensity, home visit intensity, and urgency also influence waiting times. For patients with life-threatening complaints waiting times increase sharply with the distance.

摘要

背景:大规模非工作时间全科医生合作社的引入引发了一些问题,即合作社与患者家庭之间的距离增加,以及紧急情况下家庭出诊的等待时间不断延长。我们研究了患者家庭出诊等待时间与到全科医生合作社距离之间的关系。此外,我们还调查了其他因素(交通强度、家庭出诊强度、一天中的时间以及紧急程度)是否会影响等待时间。 方法:在四个全科医生合作社进行横断面研究。我们使用方差分析来计算不同类别交通强度、家庭出诊强度、一天中的时间和紧急程度下的等待时间。我们使用多元逻辑回归分析来计算这些因素在多大程度上影响紧急情况下达到目标的能力。 结果:5827次会诊的平均等待时间为30.5分钟。交通强度、家庭出诊强度、一天中的时间以及投诉的紧急程度似乎都对等待时间有显著影响。所有患者中有88.7%在1小时内得到诊治。在危及生命的投诉(U1)情况下,68.8%的患者在15分钟内得到诊治,95.6%的急性投诉(U2)患者在1小时内得到诊治。对于危及生命投诉(U1)的患者,达到15分钟时间目标的出诊百分比从86.5%(距离小于2.5公里)降至(等于或大于20公里)的16.7%。 讨论与结论:尽管家庭出诊等待时间随着与全科医生合作社距离的增加而增加,但交通强度、家庭出诊强度和紧急程度似乎也会影响等待时间。对于危及生命投诉的患者,等待时间会随着距离急剧增加。

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本文引用的文献

[1]
Does setting up out of hours primary care cooperatives outside a hospital reduce demand for emergency care?

Emerg Med J. 2004-11

[2]
A systematic review of the effect of different models of after-hours primary medical care services on clinical outcome, medical workload, and patient and GP satisfaction.

Fam Pract. 2003-6

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BMJ. 1998-5-16

[4]
Changing the pattern out of hours: a survey of general practice cooperatives.

BMJ. 1997-1-18

[5]
Out of hours primary care.

BMJ. 1997-1-18

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