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全民健康系统中基层医疗预约诊疗国家电子预约系统的评估

Evaluation of a national e-booking system for medical consultation in primary care in a universal health system.

作者信息

Motulsky Aude, Bosson-Rieutort Delphine, Usher Susan, David Geneviève, Moreault Marie-Pierre, Gagnon Marie-Pierre, Schuster Tibor, Sicotte Claude

机构信息

Research Center, Centre hospitalier de l'Université de Montréal, Montreal, Canada; Department of Management, Evaluation and Health Policy, School of public health, Université de Montréal, Montreal, Canada.

Department of Management, Evaluation and Health Policy, School of public health, Université de Montréal, Montreal, Canada; Centre de recherche en santé publique, Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada.

出版信息

Health Policy. 2023 May;131:104759. doi: 10.1016/j.healthpol.2023.104759. Epub 2023 Mar 3.

Abstract

PURPOSE

The Rendez-vous Santé Québec is a national online booking (e-booking) system of medical appointments in primary care rolled out in 2018 in Québec (Canada). The objectives of this study were to describe the adoption by targeted users, and analyze the facilitating and limiting factors at the technological, individual and organizational levels to inform policy makers.

METHODS

A mixed methods evaluation was conducted involving interviews with key stakeholders (n = 40), audit logs of the system in 2019, and a population-based survey (n = 2 003). All data were combined to analyze facilitating and limiting factors, based on the DeLone and McLean framework.

RESULTS

The RVSQ e-booking system had a low adoption across the province mainly because it was poorly aligned with the diversity of organizational and professional practices. The other commercial e-booking systems already used by clinics seemed better adapted to interdisciplinary care, patient prioritization and advanced access. e-Booking system was appreciated by patients, but has implications for the performance of primary care organization that goes beyond scheduling management issues, with potential detrimental consequences for care continuity and appropriateness. Further research is needed to define how e-booking systems could support a better alignment between primary care innovative practices and improve the fit between patients' needs and resources availability in primary care.

摘要

目的

魁北克健康预约系统(Rendez-vous Santé Québec)是2018年在加拿大魁北克推出的一项全国性基层医疗预约在线(电子预约)系统。本研究的目的是描述目标用户的采用情况,并分析技术、个人和组织层面的促进因素和限制因素,以为政策制定者提供参考。

方法

进行了一项混合方法评估,包括对关键利益相关者的访谈(n = 40)、2019年系统的审计日志以及一项基于人群的调查(n = 2003)。所有数据根据DeLone和McLean框架进行合并,以分析促进因素和限制因素。

结果

魁北克健康预约电子系统在全省的采用率较低,主要原因是它与组织和专业实践的多样性不太匹配。诊所已经使用的其他商业电子预约系统似乎更适合跨学科护理、患者优先级确定和提前预约。电子预约系统受到患者的好评,但对基层医疗组织的绩效影响超出了日程安排管理问题,可能对护理的连续性和适当性产生不利后果。需要进一步研究来确定电子预约系统如何能够支持基层医疗创新实践之间更好的协调,并改善基层医疗中患者需求与资源可用性之间的匹配度。

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