National Primary Care Research and Development Centre, University of Manchester, Manchester M13 9PL, UK.
BMC Fam Pract. 2010 Aug 28;11:61. doi: 10.1186/1471-2296-11-61.
The 2007/8 GP Access Survey in England measured experience with five dimensions of access: getting through on the phone to a practice, getting an early appointment, getting an advance appointment, making an appointment with a particular doctor, and surgery opening hours. Our aim was to identify predictors of patient satisfaction and experience with access to English primary care.
8,307 English general practices were included in the survey (of 8,403 identified). 4,922,080 patients were randomly selected and contacted by post and 1,999,523 usable questionnaires were returned, a response rate of 40.6%. We used multi-level logistic regressions to identify patient, practice and regional predictors of patient satisfaction and experience.
After controlling for all other factors, younger people, and people of Asian ethnicity, working full time, or with long commuting times to work, reported the lowest levels of satisfaction and experience of access. For people in work, the ability to take time off work to visit the GP effectively eliminated the disadvantage in access. The ethnic mix of the local area had an impact on a patient's reported satisfaction and experience over and above the patient's own ethnic identity. However, area deprivation had only low associations with patient ratings. Responses from patients in small practices were more positive for all aspects of access with the exception of satisfaction with practice opening hours. Positive reports of access to care were associated with higher scores on the Quality and Outcomes Framework and with slightly lower rates of emergency admission. Respondents in London were the least satisfied and had the worst experiences on almost all dimensions of access.
This study identifies a number of patient groups with lower satisfaction, and poorer experience, of gaining access to primary care. The finding that access is better in small practices is important given the increasing tendency for small practices to combine into larger units. Consideration needs to be given to ways of retaining these and other benefits of small practice size when primary care services are reconfigured. Differences between population groups (e.g. younger people, ethnic minorities) may be due to differences in actual care received or different response tendencies of different groups. Further analysis is needed to determine whether case-mix adjustment is required when comparing practices serving different populations.
2007/8 年英格兰全科医生就诊调查测量了五个方面的就诊可及性：打电话到诊所、预约早期就诊、预约提前就诊、预约特定医生和手术开放时间。我们的目的是确定影响英国初级保健就诊可及性和患者满意度的因素。
该调查纳入了 8307 家英格兰全科诊所（共识别出 8403 家）。通过邮件随机抽取 492.208 名患者，共收回 199.9523 份有效问卷，回复率为 40.6%。我们使用多水平逻辑回归分析确定患者、诊所和地区因素对患者满意度和就诊可及性体验的预测因素。
在控制所有其他因素后，年轻人和亚裔患者、全职工作者或通勤时间较长的患者报告就诊可及性和体验的满意度最低。对于在职人员来说，能够请假去看全科医生实际上消除了就诊可及性方面的劣势。当地的种族构成对患者报告的满意度和体验有影响，超出了患者自身的种族身份。然而，地区贫困程度与患者评分的相关性较低。小型诊所的患者对所有就诊可及性方面的评价都更为积极，除了对诊所开放时间的满意度。对医疗保健获得途径的积极评价与质量和结果框架（Quality and Outcomes Framework）的得分较高以及急诊入院率略低有关。伦敦的受访者在几乎所有就诊可及性方面的满意度最低，体验最差。
本研究确定了一些对获得初级保健服务的满意度较低、体验较差的患者群体。在小诊所就诊的可及性更好的发现很重要，因为小诊所越来越倾向于合并成更大的单位。在重新配置初级保健服务时，需要考虑如何保留这些和小诊所规模的其他优势。人群群体之间的差异（例如，年轻人、少数族裔）可能是由于实际接受的护理不同或不同群体的反应倾向不同所致。需要进一步分析是否需要根据服务不同人群的诊所进行病例组合调整。
