Bagshaw Philip, Bagshaw Susan, Frampton Christopher, Gauld Robin, Green Terri, Harris Charlotte, Hornblow Andrew, Hudson Ben, Raymont Antony, Richardson Ann, Shaw Carl, Toop Les
Chair, Canterbury Charity Hospital Trust, Christchurch and Clinical Associate Professor, University of Otago, Christchurch.
Senior Lecturer, Department of Paediatrics, University of Otago, Christchurch.
N Z Med J. 2017 Mar 24;130(1452):23-38.
In this pilot study, the primary aim was to compare four potential methods for undertaking a national survey of unmet secondary healthcare need in New Zealand (one collecting data from GPs, and three from community surveys). The secondary aim was to obtain an estimate of the prevalence of unmet secondary healthcare need, to inform sample size calculations for a national survey.
An electronic system was set up for GPs in Christchurch (Pegasus PHO) and Auckland (Auckland PHO) to record cases of unmet need as encountered in clinics. For the community surveys, a questionnaire developed by the authors was administered to people from the same electoral wards as the GP clinics. Three modes of questionnaire administration were trialled: online, telephone and face-to-face interview. Random population sampling from the Māori and General Electoral Rolls was used to identify eligible survey participants until there were approximately 200 respondents for each method in each city. Data collection took place from November 2015 to February 2016.
GP reports: Pegasus PHO: 8/78 eligible practices recorded 28 cases of unmet secondary healthcare need in 10 weeks. Auckland PHO: 3/26 practices participated and recorded no cases in three weeks. Surveys: 1,277 interviews were completed (online 428, telephone 447, face-to-face 402). For primary healthcare, 211/1,277 (16.5%) had missed a GP visit because of cost (online 25.0%, telephone 11.6%, face-to-face 12.9%). For secondary healthcare, 119/1,277 (9.3%) reported unmet healthcare need that had been identified by a health professional (online 11.2%; telephone 9.2%; face-to-face 7.5%). Of these, 75/119 (63.0%) required a consultation, and 47/119 (39.5%) required a procedure. Completed interview rates as a percentage of names on the Electoral Roll were low (online 8.8%, telephone 15.4%, face-to-face 13.9%), affected by changed addresses and lack of listed telephone numbers. The response rate for those with valid phone numbers was 47.6%, and for those with valid addresses was 31.5%.
Using the Electoral Rolls to identify respondents is problematic. For a national survey, random population sampling by address, similar to the method employed for the New Zealand Health Survey, but giving respondents a choice between face-to-face and phone interviews, is proposed. Asking GPs to record data on unmet need for secondary care was not successful. Our pilot study suggests there is sufficient unmet secondary healthcare need in New Zealand to merit a national survey.
在这项试点研究中，主要目的是比较新西兰进行全国性未满足的二级医疗需求调查的四种潜在方法（一种是从全科医生处收集数据，另外三种是通过社区调查）。次要目的是获得未满足的二级医疗需求患病率的估计值，为全国性调查的样本量计算提供依据。
为克赖斯特彻奇（飞马初级卫生组织）和奥克兰（奥克兰初级卫生组织）的全科医生建立了一个电子系统，用于记录诊所中遇到的未满足需求病例。对于社区调查，作者编制的问卷被发放给与全科医生诊所来自相同选区的人群。试验了三种问卷发放方式：在线、电话和面对面访谈。从毛利人和普通选民名册中进行随机人口抽样，以确定符合条件的调查参与者，直到每个城市的每种方法大约有200名受访者。数据收集于2015年11月至2016年2月进行。
全科医生报告：飞马初级卫生组织：在10周内，78家符合条件的诊所中有8家记录了28例未满足的二级医疗需求病例。奥克兰初级卫生组织：26家诊所中有3家参与，在3周内未记录到病例。调查：共完成了1277次访谈（在线428次、电话447次、面对面402次）。对于初级医疗，1277人中的211人（16.5%）因费用问题错过了看全科医生的机会（在线25.0%、电话11.6%、面对面12.9%）。对于二级医疗，1277人中的119人（9.3%）报告有未满足的医疗需求，这些需求已被卫生专业人员识别（在线11.2%；电话9.2%；面对面7.5%）。其中，75/119（63.0%）需要会诊，47/119（39.5%）需要进行手术。作为选民名册上姓名百分比的完整访谈率较低（在线8.8%、电话15.4%、面对面13.9%），受地址变更和电话号码未列出的影响。有有效电话号码者的回复率为47.6%，有有效地址者的回复率为31.5%。
使用选民名册识别受访者存在问题。对于全国性调查，建议采用类似于新西兰健康调查所采用的按地址进行随机人口抽样的方法，但要让受访者在面对面访谈和电话访谈之间进行选择。要求全科医生记录二级医疗未满足需求的数据并不成功。我们的试点研究表明，新西兰存在足够多未满足的二级医疗需求，值得进行全国性调查。
