Lay-Flurrie Sarah, Mathieu Edouard, Bankhead Clare, Nicholson Brian D, Perera-Salazar Rafael, Holt Tim, Hobbs F D Richard, Salisbury Chris
Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK.
BMC Health Serv Res. 2019 Apr 6;19(1):219. doi: 10.1186/s12913-019-4036-y.
Primary care workload is high and increasing in the United Kingdom. We sought to examine the association between rates of primary care consultation and outcomes in England.
Cross sectional observational study of routine electronic health care records in 283 practices from the Clinical Practice Research Datalink from April 2013 to March 2014. Outcomes included mortality rate, hospital admission rate, Quality and Outcomes Framework (QOF) performance and patient satisfaction. Relationships between consultation rates (with a general practitioner (GP) or nurse) and outcomes were investigated using negative binomial and ordinal logistic regression models.
Rates of GP and nurse consultation (per patient person-year) were not associated with mortality or hospital admission rates: mortality incidence rate ratio (IRR) per unit change in GP/ nurse consultation rate = 1.01, 95% CI [0.98 to 1.04]/ 0.97, 95% CI [0.93 to 1.02]; hospital admission IRR per unit change in GP/ nurse consultation rate = 1.02, 95% CI [0.99 to 1.04]/ 0.98, 95% CI [0.94 to 1.032]. Higher rates of nurse but not GP consultation were associated with higher QOF achievement: OR = 1.91, 95% CI [1.39 to 2.62] per unit change in nurse consultation rate vs. OR = 1.04, 95% CI [0.87 to 1.24] per unit change in GP consultation rate. The association between the rates of GP/ nurse consultations and patient satisfaction was mixed.
There are few associations between primary care consultation rates and outcomes. Previously identified demographic and staffing factors, rather than practice workload, appear to have the strongest relationships with mortality, admissions, performance and satisfaction. Studies with more detailed patient-level data would be required to explore these findings further.
在英国，基层医疗工作量很大且呈上升趋势。我们试图研究英格兰基层医疗咨询率与治疗结果之间的关联。
对2013年4月至2014年3月期间临床实践研究数据链中283家医疗机构的常规电子医疗记录进行横断面观察研究。结果包括死亡率、住院率、质量与结果框架（QOF）绩效以及患者满意度。使用负二项式和有序逻辑回归模型研究咨询率（与全科医生（GP）或护士）与结果之间的关系。
全科医生和护士的咨询率（每人每年）与死亡率或住院率无关：全科医生/护士咨询率每单位变化的死亡率发病率比（IRR）=1.01，95%置信区间[0.98至1.04]/0.97，95%置信区间[0.93至1.02]；全科医生/护士咨询率每单位变化的住院IRR =1.02，95%置信区间[0.99至1.04]/0.98，95%置信区间[0.94至1.032]。护士咨询率较高而非全科医生咨询率较高与更高的QOF成就相关：护士咨询率每单位变化的优势比（OR）=1.91，95%置信区间[1.39至2.62]，而全科医生咨询率每单位变化的OR =1.04，95%置信区间[0.87至1.24]。全科医生/护士咨询率与患者满意度之间的关联较为复杂。
基层医疗咨询率与治疗结果之间几乎没有关联。先前确定的人口统计学和人员配备因素，而非医疗机构工作量，似乎与死亡率、住院率、绩效和满意度之间存在最强的关系。需要进行更详细的患者层面数据研究来进一步探索这些发现。
