Calnan M, Butler J R
Health Services Research Unit, University of Kent, Canterbury, England.
Soc Sci Med. 1988;26(4):435-41. doi: 10.1016/0277-9536(88)90312-7.
A lack of time is one of the major reasons given to account for low quality care provided in general practice. One of the basic assumptions inherent in this explanation is that activities in general practice are shaped by the level of patient demand and general practitioners have little control over their work. The objective of this study is to explore empirically this assumption that general practice is demand led by examining the relationship between list size and the time general practitioners spend at work-related activities. The analysis uses data gathered from a survey carried out on a nationally representative sample of unrestricted principals (N = 1419) living in England and Wales. The results show that list size is statistically significantly associated with each of the different indices of time allocation, although it is only relatively strongly associated with hours spent on surgery consultations and surgery consultation rates. The implications of these findings are discussed and it is suggested that the demand led model provides only a partial explanation for variations in time allocation in general practice.
时间不足是人们给出的解释全科医疗中医疗服务质量低下的主要原因之一。这一解释背后的一个基本假设是，全科医疗中的活动是由患者需求水平决定的，全科医生对自己的工作几乎没有控制权。本研究的目的是通过考察患者名单规模与全科医生在与工作相关活动上花费的时间之间的关系，以实证方式探究全科医疗由需求主导这一假设。该分析使用了对居住在英格兰和威尔士的具有全国代表性的无限制全科医生样本（N = 1419）进行调查所收集的数据。结果表明，患者名单规模与时间分配的各项不同指标在统计学上均显著相关，尽管它仅与手术咨询所花费的时间以及手术咨询率有相对较强的关联。本文讨论了这些发现的意义，并指出需求主导模型仅对全科医疗中时间分配的差异提供了部分解释。
