Department of General Practice, University of Antwerp, Universiteitsplein 1, Gebouw R, 3de verd, B-2610 Wilrijk, Belgium.
BMC Health Serv Res. 2010 Jul 30;10:222. doi: 10.1186/1472-6963-10-222.
Out-of-hours care in the primary care setting is rapidly changing and evolving towards general practitioner 'cooperatives' (GPC). GPCs already exist in the Netherlands, the United Kingdom and Scandinavia, all countries with strong general practice, including gatekeepers' role. This intervention study reports the use and caseload of out-of-hours care before and after implementation of a GPC in a well subscribed region in a country with an open access health care system and no gatekeepers' role for general practice.
We used a prospective before/after interventional study design. The intervention was the implementation of a GPC.
One year after the implementation of a GPC, the number of patient contacts in the intervention region significantly increased at the GPC (OR: 1.645; 95% CI: 1.439-1.880), while there were no significant changes in patient contacts at the Emergency Department (ED) or in other regions where a simultaneous registration was performed. Although home visits decreased in all general practitioner registrations, the difference was more pronounced in the intervention region (intervention region: OR: 0.515; 95% CI: 0.411-0.646, other regions: OR: 0.743; 95% CI: 0.608-0.908). At the ED we observed a decrease in the number of trauma cases (OR: 0.789; 95% CI: 0.648-0.960) and of patients who came to hospital by ambulance (OR: 0.687; 95% CI: 0.565-0.836).
One year after its implementation more people seek help at the GPC, while the number of contacts at the ED remains the same. The most prominent changes in caseload are found in the trauma cases. Establishing a GPC in an open health care system, might redirect some patients with particular medical problems to primary care. This could lead to a lowering of costs or a more cost-effective out of hours care, but further research should focus on effective usage to divert patient flows and on quality and outcome of care.
初级保健机构的非工作时间医疗服务正在迅速变化和发展，朝着全科医生“合作社”（GPC）的方向发展。GPC 已经存在于荷兰、英国和斯堪的纳维亚，这些国家的全科医学都很发达，包括守门人角色。这项干预研究报告了在一个实行开放医疗保健系统且没有守门人角色的国家的一个订阅量很大的地区，在实施 GPC 前后的非工作时间医疗服务使用情况和病例量。
我们使用了前瞻性的前后干预研究设计。干预措施是实施 GPC。
在实施 GPC 一年后，干预地区的患者就诊数量在 GPC 显著增加（OR：1.645；95%CI：1.439-1.880），而急诊部（ED）或同时进行注册的其他地区的患者就诊数量没有显著变化。尽管所有全科医生注册的家访数量都有所下降，但在干预地区更为明显（干预地区：OR：0.515；95%CI：0.411-0.646，其他地区：OR：0.743；95%CI：0.608-0.908）。在 ED，我们观察到创伤病例数量减少（OR：0.789；95%CI：0.648-0.960）和通过救护车来医院的患者数量减少（OR：0.687；95%CI：0.565-0.836）。
实施一年后，更多的人在 GPC 寻求帮助，而 ED 的就诊人数保持不变。病例量的最大变化发生在创伤病例中。在开放的医疗保健系统中建立 GPC，可能会将一些有特定医疗问题的患者转至初级保健。这可能会降低成本或提供更具成本效益的非工作时间医疗服务，但进一步的研究应集中在有效利用以转移患者流量以及关注护理质量和结果上。
Zotero 插件