Department of Social Statistics, School of Social Sciences, University of Manchester, Oxford Road, M14 7EQ, Manchester, UK.
Division of Population Health, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, M14 7EQ, Manchester, UK.
Int J Popul Data Sci. 2021 Oct 6;6(1):1401. doi: 10.23889/ijpds.v6i1.1401. eCollection 2021.
Poor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual's ability to access general practice services.
To determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model.
We linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient's home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient's home practice provided an extended hours service.
The number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use.
The results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.
普遍认为，医疗体系面临的压力越来越大以及患者满意度低，导致人们难以获得全科医生服务。最近，英格兰采取了一些措施，通过提供晚间和周末预约服务来扩大服务范围。这些服务采用中心辐射模式提供。英国国家医疗服务体系的目标要求延长开放时间，作为增加初级保健服务可及性的一种机制，这一目标基于未满足的需求是由合适时间的预约不足造成的假设。然而，研究表明，其他因素也会影响获得医疗保健的机会，而且可能不仅仅是预约机会的缺乏限制了个人获得全科医生服务的能力。
确定距离和贫困是否会影响使用中心辐射模式的延长服务时间的全科医生服务的利用率。
我们将 158 家全科医生手术中心的 25408 名患者的延长服务时间预约数据与一般实践患者调查（GPPS）调查、贫困统计数据和初级保健注册数据相关联。我们使用负二项回归来估计大曼彻斯特城市地区的距离和贫困对延长时间的全科医生服务利用率的影响。距离定义为延长服务提供者位置与患者家庭医生之间的直线距离，使用英格兰多因素剥夺指数根据家庭医生来确定地区贫困情况，熟悉度定义为患者的家庭医生是否提供延长服务时间。
在全科医生手术中心层面，服务的使用次数与距离有关。在考虑距离因素后，中心辐射模式下的服务使用次数高于非中心辐射模式。贫困与使用率无关。
结果表明，延长服务时间存在地理不平等。可能有许多患者有未满足的需求，而通过中心辐射模式延长服务时间并不能解决他们的服务可及性障碍。研究结果可能有助于在设计扩展访问服务时选择中心辐射模式的实践。提供者应考虑为那些距离中心辐射模式的实践最远的患者提供改善服务的措施。这在缩小健康不平等差距的背景下尤为重要。
