Netherlands Institute for Health Services Research, Nivel, Utrecht, The Netherlands.
Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, Tilburg, The Netherlands.
BMC Health Serv Res. 2023 Jun 27;23(1):696. doi: 10.1186/s12913-023-09654-7.
Experiences with organizational changes in daytime general practices and out-of-hours (OOH) services during the COVID-19 pandemic may help to address the challenges in general practice care that were already a concern before the crisis. This study aimed to describe these experiences and the potential usefulness of the organizational changes for future general practice care and any future pandemics.
Semi-structured interviews were performed among 11 directors of OOH services, and 19 (locum) general practitioners (GPs) or practice managers, who were purposively sampled. Video or telephone interviews were performed in two rounds: between November 2020 and January 2021 and between May 2021 and August 2021. The data were analyzed using thematic analysis methods.
Three themes emerged from the data: (1) Changes in the triage procedures; in GP practices and OOH services, stricter triage criteria were implemented, and GPs were more actively involved in the triage process. These measures helped to reduce the number of 'low urgency' face-to-face consultations. (2) Changes in GP care; there was a shift towards video and telephone consultations, allowing GPs to spend more time with patients during the remaining face-to-face consultations. For chronic patients, the shift towards telemonitoring appeared to encourage self-care, and postponing face-to-face consultations for regular checkups appeared to be unproblematic for stable patients. (3) Coordination of GP care and information communication flow during the COVID-19 pandemic; OOH directors perceived a lack of consistency in the information from various governmental and non-governmental parties on containment measures and guidelines related to COVID-19, making it difficult to act on them. The COVID-19 pandemic intensified collaboration between GPs, OOH services, and other healthcare professionals.
The results of this study indicate that some of the organizational changes, such as stricter triage, remote consultations, and changes in managed care of chronic patients, may help in tackling the pre-existing challenges in GP care from before the COVID-19 pandemic. However, more extensive research and continuous monitoring are necessary to establish the effects on patients and their health outcomes. To navigate future pandemics, the intensified collaboration between health professionals should be maintained, while there is considerable room for improvement in the provision of unambiguous information.
在 COVID-19 大流行期间，日间全科医生和非工作时间（OOH）服务的组织变革经验可能有助于应对大流行前已经引起关注的全科医生护理方面的挑战。本研究旨在描述这些经验以及组织变革对未来全科医生护理和任何未来大流行的潜在有用性。
对 OOH 服务的 11 名主任和 19 名（临时）全科医生（GP）或诊所经理进行了半结构化访谈，他们是通过目的性抽样选择的。视频或电话访谈分两轮进行：一轮在 2020 年 11 月至 2021 年 1 月之间，另一轮在 2021 年 5 月至 8 月之间。使用主题分析方法对数据进行分析。
从数据中出现了三个主题：（1）分诊程序的变化；在全科医生实践和 OOH 服务中，实施了更严格的分诊标准，GP 更积极地参与分诊过程。这些措施有助于减少“低紧急度”的面对面咨询数量。（2）GP 护理的变化；更多地转向视频和电话咨询，使 GP 能够在剩余的面对面咨询中花费更多时间与患者在一起。对于慢性患者，转向远程监测似乎鼓励了自我护理，并且对于稳定患者来说，推迟常规检查的面对面咨询似乎没有问题。（3）COVID-19 大流行期间 GP 护理的协调和信息沟通流程；OOH 主任认为，来自政府和非政府各方关于遏制措施和 COVID-19 相关指南的信息不一致，这使得难以采取行动。COVID-19 大流行加剧了全科医生、OOH 服务和其他医疗保健专业人员之间的合作。
本研究的结果表明，一些组织变革，如更严格的分诊、远程咨询以及对慢性患者的管理式护理的改变，可能有助于解决 COVID-19 大流行前全科医生护理方面已经存在的挑战。然而，需要进行更广泛的研究和持续监测，以确定对患者及其健康结果的影响。为了应对未来的大流行，应保持卫生专业人员之间的合作，同时在提供明确信息方面还有很大的改进空间。
