Department of Community Health Sciences, Université de Sherbrooke, Canadian Research Chair in Clinical Governance on Primary Health Care, Longueuil, QC, Canada.
Université de Sherbrooke, Longueuil, QC, Canada.
Health Policy. 2020 Aug;124(8):787-795. doi: 10.1016/j.healthpol.2020.05.023. Epub 2020 Jun 1.
Many health systems have centralized waiting lists (CWLs), but there is limited evidence on CWL effectiveness and how to design and implement them.
To understand how CWLs' design and implementation influence their use and effect on access to healthcare.
We conducted a realist review (n = 21 articles), extracting context-intervention-mechanism-outcome configurations to identify demi-regularities (i.e., recurring patterns of how CWLs work).
In implementing non-mandatory CWLs, acceptability to providers influences their uptake of the CWL. CWL eligibility criteria that are unclear or conflict with providers' role or judgement may result in inequities in patient registration. In CWLs that prioritize patients, providers must perceive the criteria as clear and appropriate to assess patients' level of need; otherwise, prioritization may be inconsistent. During patients' assignment to service providers, providers may select less-complex patients to obtain CWLs rewards or avoid penalties; or may select patients for other policies with stronger incentives, disregarding the established patient order and leading to inequities and limited effectiveness.
These findings highlight the need to consider provider behaviours in the four sequential CWL design components: CWL implementation, patient registration, patient prioritization and patient assignment to providers. Otherwise, CWLs may result in limited effects on access or lead to inequities in access to services.
许多医疗体系都设有集中候诊名单（CWL），但关于 CWL 的效果以及如何设计和实施 CWL 的证据有限。
了解 CWL 的设计和实施如何影响其对医疗服务获取的使用和效果。
我们进行了一项真实主义综述（n = 21 篇文章），提取了情境-干预-机制-结果配置，以确定半规律性（即 CWL 运作的常见模式）。
在实施非强制性 CWL 时，提供者的可接受性会影响他们对 CWL 的采用。CWL 资格标准不明确或与提供者的角色或判断相冲突，可能导致患者登记的不平等。在以患者为优先级的 CWL 中，提供者必须认为标准明确且适合评估患者的需求水平；否则，优先级可能不一致。在为服务提供者分配患者时，提供者可能会选择较简单的患者来获得 CWL 奖励或避免惩罚；或者可能会选择其他政策激励更强的患者，而不顾已确定的患者顺序，导致不平等和效果有限。
这些发现强调了在 CWL 的四个连续设计组件（CWL 实施、患者登记、患者优先级和患者分配给提供者）中考虑提供者行为的必要性。否则，CWL 可能对获取服务的机会产生有限的影响或导致服务获取机会的不平等。
