Hider Phil, Lay-Yee Roy, Crampton Peter, Davis Peter
Department of Public Health and General Practice, Christchurch School of Medicine and Health Sciences, University of Otago, Christchurch, New Zealand.
J Health Serv Res Policy. 2007 Oct;12(4):215-22. doi: 10.1258/135581907782101525.
New Zealand has experienced restructuring and reform of primary health care since the 1980s, including the introduction of commercial clinics and increasing numbers of practices run by community-governed organizations. Our aim was to compare commercial, community-governed and traditional practices in five key domains: access; coordination and continuity of care; communication and patient centredness; population health and preventive health; and chronic disease management.
A nationally representative, multistage probability sample of private general practitioners, stratified by geographical location and practice type, was drawn. Representative samples of urban commercial clinics and of practices governed by community organizations were obtained for the same period (2001-02). All doctors were asked to provide data on themselves, their practice, and to report on a 25% sample of patients in two periods of one week.
Among the three practice types, commercial clinics differed most in their organization; they charged higher fees and employed more staff, although their doctors were less experienced. Community-governed practices were visited by more people from lower socioeconomic groups. Commercial clinic patients were more likely to be younger and less likely to have an ongoing relationship with the clinic. They frequently attended for self-limiting problems related to injuries or respiratory problems. Investigations, follow-up and referral rates were similar between the three practice types. Treatment rates were higher at traditional and community-governed general practices.
Rather than replicating traditional practices, new practice types provide complementary services and established services in innovative ways. The challenge is to achieve an appropriate mix of diverse providers.
自20世纪80年代以来，新西兰经历了初级卫生保健的重组和改革，包括引入商业诊所和由社区管理组织运营的诊所数量不断增加。我们的目的是在五个关键领域比较商业诊所、社区管理诊所和传统诊所：可及性；护理协调与连续性；沟通与以患者为中心；人群健康与预防保健；以及慢性病管理。
抽取了一个具有全国代表性的、按地理位置和诊所类型分层的私人全科医生多阶段概率样本。在同一时期（2001 - 02年）获取了城市商业诊所和社区组织管理诊所的代表性样本。所有医生被要求提供关于他们自己、他们诊所的数据，并报告在两个为期一周的时间段内25%的患者样本情况。
在这三种诊所类型中，商业诊所在组织方面差异最大；它们收费更高，雇佣的员工更多，尽管其医生经验较少。来自社会经济地位较低群体的人更多地就诊于社区管理诊所。商业诊所的患者更可能较年轻，并且与诊所保持长期关系的可能性较小。他们经常因与损伤或呼吸问题相关的自限性问题就诊。三种诊所类型的检查、随访和转诊率相似。传统诊所和社区管理的全科诊所的治疗率更高。
新的诊所类型并非复制传统诊所，而是以创新方式提供补充服务和既有服务。挑战在于实现不同提供者的适当组合。
