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加拿大安大略省门诊患者特征和利用模式:一项横断面研究。

Walk-in clinic patient characteristics and utilization patterns in Ontario, Canada: a cross-sectional study.

机构信息

ICES (Lapointe-Shaw, Kiran, Austin, Schultz, Tadrous, Paterson, Bhatia, Na, Ivers), Toronto, Ont.; Institute of Health Policy, Management and Evaluation (Lapointe-Shaw, Kiran, Austin, Desveaux, Martin, Paterson, Bhatia, Ivers), University of Toronto, Toronto, Ont.; Division of General Internal Medicine and Geriatrics (Lapointe-Shaw), University Health Network and Sinai Health System, Toronto, Ont.; Department of Medicine (Lapointe-Shaw, Bhatia), University of Toronto, Toronto, Ont.; Women's College Institute for Health System Solutions and Virtual Care (Lapointe-Shaw, Martin, Shuldiner, Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Toronto General Hospital Research Institute, University Health Network (Lapointe-Shaw, Salahub), Toronto, Ont.; Peter Munk Cardiac Centre, University Health Network (Bhatia), Toronto, Ont.; Department of Family and Community Medicine (Kiran) and MAP Centre for Urban Health Solutions (Kiran), St. Michael's Hospital, Toronto, Ont.; Département de médecine familiale et de médecine d'urgence (Berthelot), Université Laval, Quebec City, Qué.; Institute for Better Health, Trillium Health Partners (Desveaux), Mississauga, Ont.; Department of Family and Community Medicine (Lofters, Martin, Ivers, Kiran), University of Toronto, Toronto, Ont.; Peter Gilgan Centre for Women's Cancers (Lofters), Women's College Hospital, Toronto, Ont.; Department of Anesthesiology, Pharmacology and Therapeutics (Maclure), University of British Columbia, Vancouver, BC; Department of Family Medicine (Martin, Ivers), Women's College Hospital, Toronto, Ont.; Temerty Faculty of Medicine (Martin), University of Toronto, Toronto, Ont.; Departments of Family Medicine and Community Health Sciences (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Department of Family Practice (McCracken), University of British Columbia, Vancouver, BC; Department of Family Medicine (McCracken), Providence Health Care, Vancouver, BC; Primary Health Care Branch (Rahman), Ministry of Health, Toronto, Ont.; patient partner (Bird), Toronto, Ont.; Department of Family Medicine (Paterson), McMaster University, Hamilton, Ont.; College of Nurses of Ontario (Thakkar), Toronto, Ont.; Women's College Hospital Research Institute (Na), Women's College Hospital, Toronto, Ont.

出版信息

CMAJ Open. 2023 Apr 25;11(2):E345-E356. doi: 10.9778/cmajo.20220095. Print 2023 Mar-Apr.

Abstract

BACKGROUND

Walk-in clinics are common in North America and are designed to provide acute episodic care without an appointment. We sought to describe a sample of walk-in clinic patients in Ontario, Canada, which is a setting with high levels of primary care attachment.

METHODS

We performed a cross-sectional study using health administrative data from 2019. We compared the sociodemographic characteristics and health care utilization patterns of patients attending 1 of 72 walk-in clinics with those of the general Ontario population. We examined the subset of patients who were enrolled with a family physician and compared walk-in clinic visits to family physician visits.

RESULTS

Our study found that 562 781 patients made 1 148 151 visits to the included walk-in clinics. Most (70%) patients who attended a walk-in clinic had an enrolling family physician. Walk-in clinic patients were younger (mean age 36 yr v. 41 yr, standardized mean difference [SMD] 0.24), yet had greater health care utilization (moderate and high use group 74% v. 65%, SMD 0.20) than the general Ontario population. Among enrolled Ontarians, walk-in patients had more comorbidities (moderate and high count 50% v. 45%, SMD 0.10), lived farther from their enrolling physician (median 8 km v. 6 km, SMD 0.21) and saw their enrolling physician less in the previous year (any visit 67% v. 80%, SMD 0.30). Walk-in encounters happened more often after hours (16% v. 9%, SMD 0.20) and on weekends (18% v. 5%, SMD 0.45). Walk-in clinics were more often within 3 km of patients' homes than enrolling physicians' offices (0 to < 3 km: 32% v. 22%, SMD 0.21).

INTERPRETATION

Our findings suggest that proximity of walk-in clinics and after-hours access may be contributing to walk-in clinic use among patients enrolled with a family physician. These findings have implications for policy development to improve the integration of walk-in clinics and longitudinal primary care.

摘要

背景

在北美,上门诊所很常见,旨在提供无需预约的急性偶发性护理。我们试图描述加拿大安大略省上门诊所患者的样本,该省的初级保健服务高度普及。

方法

我们使用 2019 年的健康管理数据进行了一项横断面研究。我们将到 72 家上门诊所就诊的患者的社会人口统计学特征和医疗保健利用模式与安大略省一般人群进行了比较。我们研究了那些有家庭医生登记的患者亚组,并比较了上门诊所就诊和家庭医生就诊。

结果

我们的研究发现,562781 名患者到纳入的上门诊所就诊了 1148151 次。大多数(70%)到上门诊所就诊的患者都有登记的家庭医生。上门诊所患者更年轻(平均年龄 36 岁 v. 41 岁,标准化平均差异 [SMD] 0.24),但医疗保健利用率更高(中度和高度利用组 74% v. 65%,SMD 0.20),高于安大略省一般人群。在登记的安大略省人中,上门患者有更多的合并症(中度和高度计数 50% v. 45%,SMD 0.10),距离登记医生更远(中位数 8 公里 v. 6 公里,SMD 0.21),在前一年看医生的次数更少(任何就诊 67% v. 80%,SMD 0.30)。上门就诊更常见于下班后(16% v. 9%,SMD 0.20)和周末(18% v. 5%,SMD 0.45)。上门诊所离患者家比登记医生办公室更近(0 至 < 3 公里:32% v. 22%,SMD 0.21)。

解释

我们的研究结果表明,上门诊所的位置和下班后的可及性可能是家庭医生登记患者使用上门诊所的原因。这些发现对制定政策以改善上门诊所和纵向初级保健的整合具有重要意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c696/10139081/ca650577645b/cmajo.20220095f1.jpg

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