Sjönell G
Fam Pract. 1986 Sep;3(3):148-54. doi: 10.1093/fampra/3.3.148.
The aim of the study was to describe the changes in the way the population in the catchment area of one parish in Stockholm utilized the available out-patient services after primary health care in the area had been expanded by establishing the Matteus health centre. Primary health care resources in the district expanded from two district physicians, one assistant physician and four district nurses before the project started to 7.5 district physicians, 15 district nurses plus other assistant personnel. A controlled longitudinal before and after design was used over a period of four years, 1978-81. The results showed that the population in the study district doubled the number of visits to district physicians and nurses after establishment of the health centre. Visits to hospital out-patient clinics were reduced by 26% (40% reduction for emergency visits and 16% for polyclinic appointments). Visits to nonpublic employed physicians (private, occupational and school health physicians) decreased by 31% after establishment of the Matteus health centre. Furthermore the population decreased their utilization of the Stockholm emergency car service by 28%. These results support the workload reduction hypothesis--that an expansion of primary health care leads to a reduction of the workload of hospitals, and not an overall increase in utilization of health care.
该研究的目的是描述在斯德哥尔摩一个教区的集水区，通过建立马太福音健康中心扩大该地区的初级卫生保健后，当地居民利用现有门诊服务方式的变化。该地区的初级卫生保健资源从项目开始前的两名地区医生、一名助理医生和四名地区护士增加到7.5名地区医生、15名地区护士以及其他辅助人员。在1978 - 1981年的四年时间里采用了前后对照的纵向设计。结果显示，健康中心建立后，研究区域内居民去看地区医生和护士的次数增加了一倍。去医院门诊的次数减少了26%（急诊次数减少40%，门诊预约次数减少16%）。在马太福音健康中心建立后，去非公立执业医生（私人、职业和学校健康医生）处就诊的次数减少了31%。此外，居民使用斯德哥尔摩急救车服务的次数减少了28%。这些结果支持了工作量减少假说——即初级卫生保健的扩大导致医院工作量减少，而不是医疗保健利用率的总体增加。
