Family physician and Clinical Instructor for the Island Medical Programme on Vancouver Island, BC.
Locum family physician and hospitalist in Ontario and mentors international medical graduates for the Northern Ontario School of Medicine.
Can Fam Physician. 2021 May;67(5):e121-e129. doi: 10.46747/cfp.6705e121.
To characterize primary care physician and nurse practitioner ("GP") workload and availability, and any relationship with daytime, low-acuity emergency department (ED) and after-hours walk-in clinic (WIC) visit counts.
Retrospective database review.
Timmins, Ont, with 5 family health team (FHT) office sites, 1 after-hours FHT WIC, and 1 ED.
An anonymous data set representing 21 voluntarily enrolled GPs comprising 33 211 office appointments among 15 908 patients, plus 2043 ED visits and 2713 WIC visits, over 18 months.
Roster size corrections for inactive ("dormant") patients, nursing supports, and patient complexity (age and sex). was defined as the corrected number of office visits per patient per year. Linear and nonlinear relationships between GP availability and each roster's chronic disease burden (congestive heart failure, chronic obstructive pulmonary disease, and diabetes); ED visit count per patient; and WIC visit count per patient.
Corrections for dormant patients and then for each of relative nursing support and patient complexity changed roster sizes by a mean (SD) of -8.4% (14.5%), -7.1% to 5.6% (median -1.6%), and 32.0% (18.2%), respectively. Combining these corrections increased effective roster size by a mean (SD) of 18.4% (7.3%). Larger rosters were not proportionately more dormant. In the Timmins FHT, GPs saw unique patients about 2.05 times per year (range 1.39 to 3.81). Availability of GPs did not change with increasing numbers of patients with congestive heart failure, chronic obstructive pulmonary disease, or diabetes in the roster. The ED diversion model had low explanatory power and was likely unreliable. The WIC diversion model was more robust, predicting 0.08 fewer WIC visits per patient per year if GP availability increased from 2.0 to 3.0 visits per patient per year (relative risk reduction of 41%).
Sampled GPs manage a more complex patient population on average than their uncorrected roster sizes imply. There was no evidence that larger rosters or those with more patients with comorbid conditions reduced GP availability. Increasing physician availability might decrease WIC attendance.
描述初级保健医生和护士从业者（“GP”）的工作量和可用性，以及其与日间、低 acuity 急诊部（ED）和下班后门诊（WIC）就诊次数之间的任何关系。
回顾性数据库研究。
安大略省蒂明斯市，有 5 个家庭健康团队（FHT）办公地点、1 个下班后 FHT WIC 以及 1 个 ED。
一个匿名数据集，代表 21 名自愿参与的 GP，涵盖 15908 名患者的 33211 次门诊就诊，以及 18 个月内的 2043 次 ED 就诊和 2713 次 WIC 就诊。
为不活跃（“休眠”）患者、护理支持和患者复杂性（年龄和性别）校正名册规模。定义为每位患者每年的门诊就诊次数。分析 GP 可用性与每个名册的慢性疾病负担（充血性心力衰竭、慢性阻塞性肺疾病和糖尿病）、每位患者的 ED 就诊次数和每位患者的 WIC 就诊次数之间的线性和非线性关系。
为休眠患者、相对护理支持和患者复杂性分别校正后，名册规模平均（SD）分别变化-8.4%（14.5%）、-7.1%至 5.6%（中位数-1.6%）和 32.0%（18.2%）。将这些校正结果综合起来，有效名册规模平均（SD）增加了 18.4%（7.3%）。更大的名册规模并不意味着有更多的休眠患者。在蒂明斯 FHT，每位 GP 每年大约看 2.05 次独特的患者（范围为 1.39 至 3.81）。名册中充血性心力衰竭、慢性阻塞性肺疾病或糖尿病患者人数的增加并没有改变 GP 的可用性。ED 分流模型的解释能力较低，可能不可靠。WIC 分流模型更稳健，如果 GP 可用性从每位患者每年 2.0 次增加到 3.0 次，每年每位患者的 WIC 就诊次数预计将减少 0.08 次（相对风险降低 41%）。
抽样 GP 管理的患者群体平均比未校正名册规模所暗示的更复杂。没有证据表明更大的名册规模或更多合并症患者会降低 GP 的可用性。增加医生的可用性可能会减少 WIC 的就诊次数。
