McGeoch Graham, Holland Kieran, Kerdemelidis Melissa, Elliot Nikki, Shand Brett, Fink Catherine, Dixon Anne, Gullery Carolyn
Canterbury Initiative, Canterbury District Health Board, Christchurch, New Zealand.
Planning and Funding and Decision Support, Canterbury District Health Board, Christchurch, New Zealand.
J Prim Health Care. 2017 Dec;9(4):269-278. doi: 10.1071/HC17044.
INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.
引言
未满足的需求是卫生系统成功与否的关键指标。新西兰坎特伯雷基督城的临床医生和资助者担心未满足的健康需求被掩盖。
目的
本次调查的目的是估计在全科医疗就诊的患者中无法获得临床指示的转诊服务的比例。
方法
该调查采用了一种新颖的方法来估计未得到满足的健康需求。全科医生（n = 54）在会诊期间询问他们的患者（n = 2135）是否有任何需要转诊服务的健康需求。如果双方都认为某项服务可能有益且无法获得，则会记录在电子转诊系统中以供审查。还对实际转诊的结果进行了审查。
结果
患者群体大致代表了坎特伯雷地区的人口，但女性和中年人的样本过多，而毛利人的样本过少。根据地区人口统计数据调整后的数据显示，3.6%的患者有全科医生确认的未得到满足的健康需求。择期骨科手术、普通外科和心理健康是需求最大的领域。未得到满足的健康需求与更高的贫困程度、中年以及接受高额医疗使用补贴显著相关（P≤0.05）。
讨论
据我们所知，这是首次关于全科医生和患者对未得到满足的转诊健康需求达成一致的调查。以这种方式衡量未得到满足的健康需求与服务规划直接相关，因为所发现的差距反映了患者想要和需要的临床指示服务。该调查方法是对将转诊拒绝率作为需求衡量指标的一种改进。该方法的关键因素是利用患者发起的全科医生会诊和电子转诊系统来收集数据。
