Cragg D K, Campbell S M, Roland M O
Department of General Practice, University of Manchester, Rusholme Health Centre.
BMJ. 1994 Dec 17;309(6969):1627-9. doi: 10.1136/bmj.309.6969.1627.
To study the number, demography, and clinical details of patients who agreed or refused to attend centralised primary care centres for out of hours medical care and to study the satisfaction with the service of those who attended.
Data collected by telephonists and doctors. Satisfaction questionnaires given to patients who attended.
Five out of hours primary care centres in the United Kingdom.
All patients contacting the deputising service to request medical help out of hours who were asked to attend a primary care centre. The study terminated when 1000 patients had agreed to attend (200 from each centre). 1000 patients not agreeing to attend were also sampled.
The attendance rate varied from 8.9% to 52.3% in the five centres. The overall standardised attendance rate was 22.4%. The attendance rate was highest in children under 5 (465/2380, 19.5%) and fell with increasing age. Of the 1000 sampled non-attenders, 403 said that they had no transport and 345 said that they were too ill to attend. Those who attended were seen by the doctor more quickly. There was no significant difference between the groups in the number who received a prescription (810 attenders v 820 non-attenders, P = 0.57) or who were admitted to hospital (59 v 52, P = 0.5). Satisfaction with the service among those who attended was very high; 95% (694/731) said that they would be prepared to attend under similar circumstances in the future.
Most patients are not able or prepared to attend a central facility for primary care out of hours. Substantial cultural change will be necessary and careful consideration given to planning if such centres are to provide a major part of out of hours care.
研究同意或拒绝前往集中式初级保健中心接受非工作时间医疗服务的患者数量、人口统计学特征及临床细节，并研究前往就诊患者对该服务的满意度。
由话务员和医生收集数据。向就诊患者发放满意度调查问卷。
英国的5个非工作时间初级保健中心。
所有联系代理服务机构请求非工作时间医疗帮助并被要求前往初级保健中心的患者。当1000名患者同意就诊（每个中心200名）时研究结束。同时抽取1000名不同意就诊的患者作为样本。
5个中心的就诊率从8.9%到52.3%不等。总体标准化就诊率为22.4%。5岁以下儿童的就诊率最高（465/2380，19.5%），且随年龄增长而下降。在抽取的1000名未就诊者中，403人表示没有交通工具，345人表示病得太重无法就诊。就诊患者更快见到医生。两组在开具处方的人数（810名就诊者对820名未就诊者，P = 0.57）或住院人数（59对52，P = 0.5）方面无显著差异。就诊患者对服务的满意度非常高；95%（694/731）表示他们愿意在未来类似情况下再次就诊。
大多数患者没有能力或不愿意前往中心设施接受非工作时间的初级保健服务。如果此类中心要提供大部分非工作时间的医疗服务，将需要进行重大的文化变革，并在规划时仔细考虑。
