Warwick Applied Health, Warwick Medical School, University of Warwick, Coventry, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK; post-doctoral researcher, Anthropology Department, University of Amsterdam, Amsterdam, the Netherlands.
Br J Gen Pract. 2024 Sep 26;74(747):e674-e682. doi: 10.3399/BJGP.2023.0149. Print 2024 Oct.
Access to GP appointments is increasingly challenging in many high-income countries, with an overstretched workforce and rising demand. Various access systems have been developed and evaluated internationally.
To systematically consolidate the current international evidence base related to different types of GP access systems.
Scoping review examining international literature.
Literature searches were run across relevant databases in May 2022. Title, abstract, and full-text screenings were carried out. Data from included studies were extracted and mapped to synthesise the components and aims within different GP access systems.
In total, 49 studies were included in the review. The majority of these were set in the UK. Some access systems featured heavily in the literature, such as Advanced Access, telephone triage, and online consultations, and others less so. There were two key strategies adopted by systems that related to either changing appointment capacity or modifying patient pathways. Components related to these strategies are summarised and illustrated as a schematic representation. Most rationales behind access systems were practice, rather than patient, focused. 'Add-on' systems and aims for efficiency have become more popular in recent years.
This synthesis provides a useful tool in understanding access systems' aims, design, and implementation. With focus on alleviating demand, patient-focused outcomes appear to be underinvestigated and potentially overlooked during design and implementation. More recently, digital services have been promoted as offering patient choice and convenience. But a context where demand outweighs resources challenges the premise that extending choice is possible.
在许多高收入国家，由于劳动力过度紧张和需求不断增加，获得全科医生预约变得越来越困难。国际上已经开发和评估了各种准入系统。
系统地整合当前国际上关于不同类型的全科医生准入系统的证据基础。
对国际文献进行范围审查。
2022 年 5 月在相关数据库中进行了文献检索。进行了标题、摘要和全文筛选。从纳入的研究中提取数据并进行映射，以综合不同 GP 准入系统中的组成部分和目标。
共纳入 49 项研究。其中大部分研究是在英国进行的。一些准入系统在文献中占有重要地位，如高级准入、电话分诊和在线咨询，而其他系统则较少。有两种关键策略被系统采用，一种与改变预约能力有关，另一种与改变患者途径有关。与这些策略相关的组件被总结并以示意图的形式表示。准入系统背后的大多数理由都是以实践为导向，而不是以患者为导向。近年来，“附加”系统和提高效率的目标变得更加流行。
本综合分析提供了一个有用的工具，有助于理解准入系统的目标、设计和实施。随着对需求的关注，以患者为中心的结果似乎被调查不足，并且在设计和实施过程中可能被忽视。最近，数字服务被宣传为提供患者选择和便利。但在需求超过资源的情况下，扩大选择的前提受到挑战。
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