Engineering Systems Division, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
BMC Health Serv Res. 2011 Oct 15;11:274. doi: 10.1186/1472-6963-11-274.
Recent reforms in Portugal aimed at strengthening the role of the primary care system, in order to improve the quality of the health care system. Since 2006 new policies aiming to change the organization, incentive structures and funding of the primary health care sector were designed, promoting the evolution of traditional primary health care centres (PHCCs) into a new type of organizational unit--family health units (FHUs). This study aimed to compare performances of PHCC and FHU organizational models and to assess the potential gains from converting PHCCs into FHUs.
Stochastic discrete event simulation models for the two types of organizational models were designed and implemented using Simul8 software. These models were applied to data from nineteen primary care units in three municipalities of the Greater Lisbon area.
The conversion of PHCCs into FHUs seems to have the potential to generate substantial improvements in productivity and accessibility, while not having a significant impact on costs. This conversion might entail a 45% reduction in the average number of days required to obtain a medical appointment and a 7% and 9% increase in the average number of medical and nursing consultations, respectively.
Reorganization of PHCC into FHUs might increase accessibility of patients to services and efficiency in the provision of primary care services.
葡萄牙最近的改革旨在加强初级保健系统的作用，以提高医疗保健系统的质量。自 2006 年以来，旨在改变初级保健部门的组织、激励结构和资金的新政策被设计出来，推动传统的初级保健中心（PHCC）向新型组织单位——家庭健康单位（FHUs）转变。本研究旨在比较 PHCC 和 FHU 组织模式的绩效，并评估将 PHCC 转变为 FHU 的潜在收益。
使用 Simul8 软件为两种组织模型设计并实施了随机离散事件模拟模型。这些模型应用于大里斯本地区三个城市的 19 个初级保健单位的数据。
将 PHCC 转变为 FHU 似乎有可能在提高生产力和可及性方面产生重大改进，同时对成本没有重大影响。这种转变可能会导致获得医疗预约的平均天数减少 45%，医疗和护理咨询的平均数量分别增加 7%和 9%。
将 PHCC 重组为 FHU 可能会增加患者对服务的可及性和初级保健服务的提供效率。
