Organisation and Delivery of Care Group, Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK.
Fam Pract. 2011 Dec;28(6):677-82. doi: 10.1093/fampra/cmr029. Epub 2011 May 18.
Centralization of urgent care services may reduce access for patients living further away from primary care centres (PCCs). Telephone-based access is often proposed to remedy this.
To examine the effect of distance and rurality on the doctor's decision to manage the call by telephone or face-to-face.
Geographical analysis of routine data on calls to an out-of-hours cooperative, including logistic regression to examine the effects of distance and rurality on triage decisions.
For distances >6 km, the likelihood of receiving telephone advice only increased progressively with increasing distance from the PCC (Model 1). However, for those patients seen face-to-face, overall, there was increased likelihood of receiving a home visit (compared with PCC attendance) with increasing distance (Model 2).
Patients experience differences in how their call to out-of-hours services is managed depending on where they live. Telephone access and consultation can be used to overcome geographical barriers but do not necessarily make access geographically equitable. Those who live furthest away are more likely to receive telephone advice rather than being seen face-to-face, but paradoxically, those who do get a home visit are more likely to live at a greater distance from the PCC. These findings present important challenges to proposals to integrate urgent care services and increase telephone-based provision and suggest that attention should be given to configuring services to ensure geographical equity of access, regardless of how far away people live from health services.
紧急护理服务的集中化可能会使远离初级保健中心 (PCC) 的患者难以获得服务。通常会提出基于电话的访问方式来弥补这一不足。
研究距离和农村性对医生决定通过电话或面对面管理呼叫的影响。
对夜间合作机构的常规呼叫数据进行地理分析，包括逻辑回归来检查距离和农村性对分类决策的影响。
对于距离 >6 公里的情况，与 PCC 的距离每增加一公里，仅通过电话获得建议的可能性就会逐渐增加（模型 1）。然而，对于那些面对面就诊的患者，总体而言，随着距离的增加，到家中就诊的可能性（与 PCC 就诊相比）增加（模型 2）。
患者在呼叫夜间服务时的管理方式存在差异，具体取决于他们的居住地点。电话访问和咨询可以用来克服地理障碍，但不一定使访问在地理上公平。那些居住距离最远的人更有可能获得电话建议而不是面对面就诊，但矛盾的是，那些确实获得上门就诊的人更有可能居住在离 PCC 更远的地方。这些发现对整合紧急护理服务和增加基于电话的服务的建议提出了重要挑战，并表明应注意配置服务，以确保无论人们离卫生服务有多远，都能获得地理上公平的访问。
