Policy Innovation Research Unit, Department of Health Services Research & Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2015 Feb 9;5(2):e006090. doi: 10.1136/bmjopen-2014-006090.
To investigate patients' experiences of the choice of general practitioner (GP) practice pilot.
Mixed-method, cross-sectional study.
Patients in the UK National Health Service (NHS) register with a general practice responsible for their primary medical care and practices set geographic boundaries. In 2012/2013, 43 volunteer general practices in four English NHS primary care trusts (PCTs) piloted a scheme allowing patients living outside practice boundaries to register as an out of area patient or be seen as a day patient.
Analysis of routine data for 1108 out of area registered patients and 250 day patients; postal survey of out of area registered (315/886, 36%) and day (64/188, 34%) patients over 18 years of age, with a UK mailing address; comparison with General Practice Patient Survey (GPPS); semistructured interviews with 24 pilot patients.
Pilot patients were younger and more likely to be working than non-pilot patients at the same practices and reported generally more or at least as positive experiences than patients registered at the same practices, practices in the same PCT and nationally, despite belonging to subgroups of the population who typically report poorer than average experiences. Out of area patients who joined a pilot practice did so: after moving house and not wanting to change practice (26.2%); for convenience (32.6%); as newcomers to an area who selected a practice although they lived outside its boundary (23.6%); because of dissatisfaction with their previous practice (13.9%). Day patients attended primarily on grounds of convenience (68.8%); 51.6% of the day patient visits were for acute infections, most commonly upper respiratory infections (20.4%). Sixty-six per cent of day patients received a prescription during their visit.
Though the 12-month pilot was too brief to identify all costs and benefits, the scheme provided a positive experience for participating patients and practices.
调查患者对全科医生（GP）实践试点选择的体验。
混合方法、横断面研究。
英国国民健康服务（NHS）的患者在负责其初级医疗保健的全科医生实践中注册，并且实践具有地理边界。2012/2013 年，在四个英格兰 NHS 初级保健信托（PCT）的 43 个志愿全科医生实践中试点了一项计划，允许居住在实践边界之外的患者注册为非本地区域患者或作为日间患者就诊。
对 1108 名非本地区域注册患者和 250 名日间患者的常规数据进行分析；对 18 岁及以上、具有英国邮寄地址的非本地区域注册（315/886，36%）和日间患者（64/188，34%）进行邮政调查；与全科医生患者调查（GPPS）进行比较；对 24 名试点患者进行半结构化访谈。
试点患者比同一实践中的非试点患者年龄更小，更有可能在工作，并且报告的体验普遍更为积极，至少与在同一实践、同一 PCT 和全国范围内注册的患者一样积极，尽管他们属于那些报告体验通常较差的人群亚组。加入试点实践的非本地区域患者这样做是因为：搬家后不想改变实践（26.2%）；为了方便（32.6%）；作为新到一个地区的人，尽管他们居住在边界之外，还是选择了一个实践（23.6%）；因为对以前的实践不满意（13.9%）。日间患者主要因方便就诊（68.8%）；日间患者就诊的 51.6%是为急性感染，最常见的是上呼吸道感染（20.4%）。66%的日间患者在就诊时获得了处方。
尽管 12 个月的试点时间太短，无法确定所有的成本和收益，但该计划为参与的患者和实践提供了积极的体验。
