2003 年至 2007 年期间，英国医疗服务改革中患者对初级保健的体验变化。
Changes in patient experiences of primary care during health service reforms in England between 2003 and 2007.
机构信息
National Primary Care Research and Development Centre, University of Manchester, Manchester, United Kingdom.
出版信息
Ann Fam Med. 2010 Nov-Dec;8(6):499-506. doi: 10.1370/afm.1145.
PURPOSE
Major primary care reforms have been introduced in recent years in the United Kingdom, including financial incentives to improve clinical quality and provide more rapid access to care. Little is known about the impact of these changes on patient experience. We examine patient reports of quality of care between 2003 and 2007, including random samples of patients on practice lists and patients with long-term conditions.
METHODS
We conducted a cross-sectional design study of family practices in which questionnaires were sent to serial samples of patients in 42 representative general practices in England. Questionnaires sent to samples of patients with chronic disease (asthma, angina, and diabetes) and random samples of adult patients (excluding patients who reported any long-term condition) in 2003, 2005, and 2007 addressed issues of access, communication, continuity of care, coordination, nursing care, and overall satisfaction.
RESULTS
There were no significant changes in quality of care reported by either group of patients between 2003 and 2007 for communication, nursing care, coordination, and overall satisfaction. Some aspects of access improved significantly for patients with chronic disease, but not for the random samples of patients. Patients in both samples reported seeing their usual physician less often and gave lower satisfaction ratings for continuity of care. Most scores were significantly higher for the chronic illness samples than for the random samples of patients in 2003, even after adjusting for age.
CONCLUSIONS
There was a modest improvement in access to care for patients with chronic illness, but all patients now find it somewhat harder to obtain continuity of care. This outcome may be related to the incentives to provide rapid appointments or to the increased number of specialized clinics in primary care. The possibility of unintended effects needs to be considered when introducing pay for performance schemes.
目的
近年来，英国对初级保健进行了重大改革，包括提供财政激励措施，以提高临床质量并提供更快速的医疗服务。但是，对于这些变化对患者体验的影响，人们知之甚少。我们调查了 2003 年至 2007 年期间患者对护理质量的报告，包括实践名单上的随机患者样本和患有长期疾病的患者。
方法
我们进行了一项横断面设计研究，该研究涉及英格兰 42 个具有代表性的普通实践中的家庭实践。2003 年、2005 年和 2007 年，向患有慢性疾病（哮喘、心绞痛和糖尿病）的患者样本和随机的成年患者样本（不包括报告有任何长期疾病的患者）发送了问卷，这些问卷涉及获取途径、沟通、护理连续性、协调性、护理以及整体满意度等问题。
结果
在 2003 年至 2007 年期间，两组患者在沟通、护理、协调性和整体满意度方面报告的护理质量均无明显变化。慢性疾病患者的获取途径的某些方面有了明显改善，但对随机患者样本没有改善。两个样本的患者都报告说，他们看自己的常规医生的次数减少了，并且对护理连续性的满意度评分降低了。即使在调整了年龄因素后，2003 年，慢性疾病样本的大多数评分都明显高于随机患者样本。
结论
慢性疾病患者获得医疗服务的途径有所改善，但所有患者现在都发现获得护理连续性更加困难。这种结果可能与提供快速预约的激励措施或初级保健中增加的专科诊所数量有关。在引入绩效薪酬计划时，需要考虑可能产生的意外影响。
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