Scott-Jones Joseph, Lawrenson Ross, Maxwell Nina
Church Street Surgery Opotiki, Opotiki, New Zealand.
Rural Remote Health. 2008 Oct-Dec;8(4):1024. Epub 2008 Nov 7.
As the rural general practice workforce in New Zealand changes, after hours services are under pressure to change. This is an international problem. This article reports on an initiative in a rural New Zealand community to meet the need for after hours care. First contact for patients is with a community nursing team operating from the local health centre, complemented by on-call advice from GPs and GP clinics twice daily at weekends.
To report on the demand for after hours services generated by a geographically defined community in New Zealand.
A prospective cross-sectional survey of after hours utilization over a one month period using questionnaires was completed by the full range of healthcare professionals providing care.
A single geographically defined rural community of 9200 people in the North Island of New Zealand.
Rural GPs, community nurses and the ambulance service.
Only 90/204 patient contacts were seen by the GPs with the remainder being managed by the nurses or ambulance staff. Nurses referred more patients to the base hospital but overall 87% of contacts handled by the doctors and nurses were managed locally. Estimated out of hours contact rate was 320/1000 persons/year (including telephone consultations). For direct face-to-face contact the rate was 245/1000 per year: for Maori the rate was 425/1000 per year while for non-Maori the rate was 151/1000 per year. Ambulance services provided an urgent call service at the rate of 29/1000 persons per year.
A collaborative service providing after hours care to a rural community is described and utilization rates assessed. The model of first on-call nurse with GP back up provides a sustainable service and reduces the burden on rural doctors without reducing patient access.
随着新西兰农村全科医疗劳动力的变化，非工作时间服务面临变革压力。这是一个国际性问题。本文报道了新西兰一个农村社区为满足非工作时间护理需求而开展的一项举措。患者首先接触的是在当地健康中心工作的社区护理团队，在周末，由全科医生和全科诊所每天提供两次随叫随到的建议作为补充。
报告新西兰一个地理区域界定明确的社区对非工作时间服务的需求情况。
通过问卷调查对一个月内提供护理服务的全体医护人员进行非工作时间利用情况的前瞻性横断面调查。
新西兰北岛一个地理区域界定明确的农村社区，有9200人。
农村全科医生、社区护士和救护车服务人员。
全科医生仅诊治了90/204例患者接触病例，其余由护士或救护车工作人员处理。护士将更多患者转诊至基地医院，但总体而言，医生和护士处理的接触病例中有87%在当地得到处理。估计非工作时间接触率为每年320/1000人（包括电话咨询）。直接面对面接触率为每年245/1000人：毛利人的接触率为每年425/1000人，而非毛利人的接触率为每年151/1000人。救护车服务每年以29/1000人的比例提供紧急呼叫服务。
描述了为农村社区提供非工作时间护理的协作服务并评估了利用率。由随叫随到的护士首先提供服务，全科医生提供后援的模式提供了可持续的服务，减轻了农村医生的负担，同时又不影响患者就诊。
