Keizer Ellen, Smits Marleen, Peters Yvonne, Huibers Linda, Giesen Paul, Wensing Michel
Radboud University Medical Center, Radboud Institute for Health Sciences, 114 IQ Healthcare, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands.
Aarhus University, Research Unit for General Practice, Aarhus, Denmark.
BMC Fam Pract. 2015 Oct 28;16:157. doi: 10.1186/s12875-015-0376-9.
In the Netherlands, about half of the patient contacts with a general practitioner (GP) cooperative are nonurgent from a medical perspective. A part of these problems can wait until office hours or can be managed by the patient himself without further professional care. However, from the patient's perspective, there may be a need to contact a physician immediately. Our objective was to determine whether contacts with out-of-hours primary care made by patients with nonurgent problems are the result of patients' beliefs or of deficiencies in the healthcare system.
We performed a survey among 2000 patients with nonurgent health problems in four GP cooperatives in the Netherlands. Two GPs independently judged the medical necessity of the contacts of all patients in this study. We examined characteristics, views and motives of patients with medically necessary contacts and those without medically necessary contacts. Descriptive statistics were used to describe the characteristics, views and reasons of the patients with medically unnecessary contacts and medically necessary contacts. Differences between these groups were tested with chi-square tests.
The response rate was 32.3 % (N = 646). Of the nonurgent contacts 30.4 % were judged as medically necessary (95 % CI 27.0-34.2). Compared to patients with nonurgent but medically necessary contacts, patients with medically unnecessary contacts were younger and were more often frequent attenders. They had longer-existing problems, lower self-assessed urgency, and more often believed GP cooperatives are intended for all help requests. Worry was the most frequently mentioned motive for contacting a GP cooperative for patients with a medically unnecessary contact (45.3 %) and a perceived need to see a GP for patients with a medically necessary contact (44.2 %). Perceived availability (5.8 %) and accessibility (8.3 %) of a patient's own GP played a role for some patients.
Motives for contacting a GP cooperative are mostly patient-related, but also deficiencies in access to general practice may partly explain medically unnecessary use. Efforts to change the use of GP cooperatives should focus on education of subgroups with an increased likelihood of contact for medically unnecessary problems. Improvement of access to daytime primary care may also decrease use of the GP cooperative.
在荷兰，从医学角度来看，约一半与全科医生合作机构的患者接触并非紧急情况。这些问题中的一部分可以等到办公时间处理，或者患者自己就能处理，无需进一步的专业护理。然而，从患者的角度来看，可能需要立即联系医生。我们的目的是确定有非紧急问题的患者在非工作时间联系初级医疗服务是患者自身观念导致的，还是医疗保健系统存在缺陷所致。
我们对荷兰四个全科医生合作机构中的2000名有非紧急健康问题的患者进行了一项调查。两名全科医生独立判断本研究中所有患者联系的医疗必要性。我们研究了有医疗必要联系和无医疗必要联系的患者的特征、观点和动机。描述性统计用于描述无医疗必要联系和有医疗必要联系的患者的特征、观点和原因。用卡方检验来检验这些组之间的差异。
回复率为32.3%（N = 646）。在非紧急联系中，30.4%被判定为有医疗必要（95%置信区间27.0 - 34.2）。与有非紧急但有医疗必要联系的患者相比，无医疗必要联系的患者更年轻，且更常是频繁就诊者。他们有存在时间更长的问题，自我评估的紧急程度更低，并且更常认为全科医生合作机构适用于所有求助请求。对于无医疗必要联系的患者，担忧是联系全科医生合作机构最常提及的动机（45.3%），而对于有医疗必要联系的患者，感觉需要看全科医生是最常提及的动机（44.2%）。患者自己的全科医生的可及性（5.8%）和可获得性（8.3%）对一些患者起到了一定作用。
联系全科医生合作机构的动机大多与患者相关，但获得全科医疗服务的不足也可能部分解释了医疗上不必要的使用情况。改变全科医生合作机构使用情况的努力应集中于对有更高可能性因医疗上不必要的问题而联系的亚组进行教育。改善日间初级医疗服务的可及性也可能减少对全科医生合作机构的使用。
