Pope Catherine, Banks Jon, Salisbury Chris, Lattimer Val
School of Nursing & Midwifery, University of Southampton, Southampton, UK.
J Health Serv Res Policy. 2008 Jan;13(1):33-9. doi: 10.1258/jhsrp.2007.007039.
To examine the implementation of 'Advanced Access' as a means of improving access to primary care.
Qualitative case studies of eight English general practices undertaken as part of a mixed method study.
There was considerable variation in the interpretation and implementation of Advanced Access. Practices claiming to operate this system often did not follow its key principles. Differences between practice access systems centred on the use of 'same-day' appointments. The association of Advanced Access with same-day appointment systems was problematic as it both created antagonism to, and diverged from, the Advanced Access model. Practice staff did not necessarily share the conceptualisation of demand that underpinned Advanced Access. Other policies and targets provided further incentives to diverge from the model and these factors were compounded by informal organizational behaviours, notably the exercise of discretion, which led to adaptation.
Advanced Access was diluted because it became confused with same-day appointment systems and other incentives and targets. Its guiding philosophy of 'manageable demand' appeared counter-intuitive to staff in the context of general practice, which made its implementation problematic. As a result, the system was adapted and modified.
探讨“快速服务”作为改善初级医疗服务可及性手段的实施情况。
作为一项混合方法研究的一部分，对8家英国全科诊所进行定性案例研究。
“快速服务”的解释和实施存在很大差异。声称运行该系统的诊所往往并未遵循其关键原则。诊所就诊系统之间的差异集中在“当日”预约的使用上。“快速服务”与当日预约系统的关联存在问题，因为这既引发了对“快速服务”模式的抵触，又与之背离。诊所工作人员不一定认同支撑“快速服务”的需求概念化。其他政策和目标提供了进一步背离该模式的诱因，而这些因素因非正式组织行为（尤其是自行决定权的行使）而更加复杂，后者导致了适应性调整。
“快速服务”被淡化，因为它与当日预约系统以及其他诱因和目标混为一谈。其“可管理需求”的指导理念在全科医疗环境中对工作人员而言似乎有违直觉，这使得其实施存在问题。结果，该系统被调整和修改。
