Research Fellow, University of Melbourne Department of Rural Health. 'The Chalet', Docker Street, Wangaratta, 3677, Australia.
Wyndham House Clinic, Shepparton, 3630, Australia.
BMC Fam Pract. 2021 Jan 2;22(1):2. doi: 10.1186/s12875-020-01341-4.
Most people in Australia visit a General Practitioner each year and are free to choose their General Practitioner and/or practice on each occasion. A proportion of people visit multiple general practices, which can reduce continuity of care, a core value of general practice. Utilisation of multiple general practices is associated with metropolitan residence and younger age. However, it is unclear which factors are associated with utilisation of multiple general practices in rural areas, where there are often General Practitioner workforce shortages and higher proportions of patients who may benefit from continuity of care, including older people and people living with chronic disease. The aim of this study was to compare the characteristics of people in a rural Australian area who accessed multiple general practices in the previous year with people who had accessed one practice, or none.
A cross-sectional survey assessed self-reported utilisation and perspective of general practice services, uses of multiple practices, associated reasons, lifestyle advice and screening services received in four regional Victorian towns. Households were randomly selected and residents aged 16+ were eligible to participate in the adult survey.
Most people had attended a single general practice (78.9%), while 14.4% attended more than one practice and 6.7% attended no practices in the previous 12 months. Compared with utilisation of a single general practice, multiple general practice attendance in the previous year was associated with younger age (adjusted odds ratio (aOR 95% confidence interval) 0.98 per year (0.97-0.99), residence in the regional centre aOR 2.90(2.22-3.78), emergency department (ED) attendance in the last 12 months aOR 1.65(1.22-2.21) and no out of pocket costs aOR 1.36(1.04-1.79)). Reasons for multiple general practice attendance included availability of appointments, cost and access to specific services. Compared with multiple general practice attendance, those attending single practices reported more screening tests but similar frequency of lifestyle advice. People who accessed multiple practices were less likely to report very high satisfaction (51.7% vs 62.9% p < 0.001) or excellent degree of confidence in their doctor (42.0% vs 49.8% p = 0.006) than single practice attendees.
Those attending single practices report higher satisfaction and confidence in their GP and were less likely to attend ED. Further studies are required to test whether increasing availability of appointments and reducing out-of-pocket expenses would increase single practice attendance and/or decrease healthcare costs overall.
大多数澳大利亚人每年都会去看全科医生，他们可以自由选择每次就诊的全科医生和/或诊所。一部分人会选择多个全科医生，这可能会降低全科医疗的核心价值——连续性护理。这种现象在居住在大都市和年龄较小的人群中更为常见。然而，在农村地区，导致人们选择多个全科医生的因素尚不清楚，因为在农村地区，全科医生人手短缺，而那些可能受益于连续性护理的患者比例较高，包括老年人和患有慢性病的患者。本研究旨在比较澳大利亚农村地区，在过去一年中使用多个全科医生的人群与仅使用一个或不使用全科医生的人群的特征。
采用横断面调查，评估了四个维多利亚州乡镇的居民对全科医疗服务的使用情况及看法、使用多个全科医生的原因、相关理由、生活方式建议和筛查服务的使用情况。随机选择家庭，16 岁及以上的居民有资格参加成人调查。
大多数人（78.9%）只去了一个全科医生处就诊，14.4%的人去过多个全科医生处就诊，6.7%的人在过去 12 个月内没有去看过全科医生。与只去一个全科医生相比，在过去一年中同时使用多个全科医生就诊与年龄较小（调整后的优势比（95%置信区间）0.98 岁/年（0.97-0.99）、居住在地区中心（调整后的优势比 2.90（2.22-3.78）、过去 12 个月内到急诊就诊（调整后的优势比 1.65（1.22-2.21）和无自费费用（调整后的优势比 1.36（1.04-1.79））有关。同时使用多个全科医生的原因包括预约时间、费用和获得特定服务的机会。与同时使用多个全科医生相比，只使用一个全科医生的患者报告接受了更多的筛查测试，但生活方式建议的频率相似。同时使用多个全科医生的患者不太可能报告非常高的满意度（51.7%比 62.9%，p<0.001）或对医生的高度信任（42.0%比 49.8%，p=0.006）。
使用单个全科医生的患者报告了更高的满意度和对全科医生的信任，且他们更不可能去急诊就诊。需要进一步研究以测试增加预约机会和减少自费费用是否会增加使用单个全科医生就诊的人数，以及是否会降低整体医疗保健费用。
