Policy and Economics, School of Health Sciences, University of Manchester, Manchester.
Br J Gen Pract. 2023 Aug 31;73(734):e644-e650. doi: 10.3399/BJGP.2022.0625. Print 2023 Sep.
The recent publication of data on appointment volumes for all general practices in England has enabled representative analysis of factors affecting appointment activity rates for the first time.
To identify population, workforce, and organisational predictors of practice variations in appointment volume.
A multivariable cross-sectional regression analysis of 6284 general practices in England was undertaken using data from August-October 2022.
Multivariable regression analyses was conducted. It related population age and deprivation, numbers of GPs, nurses, and other care professionals, and organisation characteristics to numbers of appointments by staff type and to proportions of appointments on the same or next day after booking.
Appointment levels were higher at practices serving rural areas. Practices serving more deprived populations had more appointments with other care professionals but not GPs. One additional full-time equivalent (FTE) GP was associated with an extra 175 appointments over 3 months. Additional FTEs of other staff types were associated with larger differences in appointment rates (367 appointments per additional nurse and 218 appointments per additional other care professional over 3 months). There was evidence of substitution between staff types in appointment provision. Levels of staffing were not associated with proportions of same-or next-day appointments.
Higher staffing levels are associated with more appointment provision, but not speed of appointment availability. New information on activity levels has shown evidence of substitution between GPs and other care professionals in appointment provision and demonstrated additional workload for practices serving deprived and rural areas.
最近公布了英格兰所有全科医生预约量的数据，这使得首次能够对影响预约活动率的因素进行代表性分析。
确定影响预约量的人口、劳动力和组织因素。
使用 2022 年 8 月至 10 月的数据，对英格兰 6284 家全科诊所进行了多变量横截面回归分析。
进行了多变量回归分析。它将人口年龄和贫困程度、全科医生、护士和其他护理专业人员的数量以及组织特征与按员工类型预约的数量以及预约后同一天或次日的比例相关联。
在服务于农村地区的实践中，预约水平较高。为贫困程度较高的人群提供服务的实践中，预约其他护理专业人员的次数较多，但预约全科医生的次数较少。每增加一名全职等效（FTE）全科医生，在 3 个月内就会额外增加 175 次预约。其他员工类型的额外 FTE 与预约率的差异更大（每增加一名护士 367 次预约，每增加一名其他护理专业人员 218 次预约，持续 3 个月）。在预约提供方面，各员工类型之间存在替代关系。人员配备水平与同日或次日预约的比例无关。
较高的人员配备水平与更多的预约提供相关，但与预约可用性的速度无关。关于活动水平的新信息表明，在预约提供方面，全科医生和其他护理专业人员之间存在替代关系，并表明为贫困和农村地区服务的实践增加了额外的工作量。
