Salisbury C
Department of Primary Health Care and General Practice, Imperial College School of Medicine at St Mary's, London.
BMJ. 1997 Jan 18;314(7075):182-6. doi: 10.1136/bmj.314.7075.182.
To evaluate an out of hours cooperative of general practitioners compared with a deputising service.
Observational study of two services in overlapping geographical areas.
A general practice cooperative in Kensington, Chelsea, and Westminster and a deputising service operating in that area and the neighbouring area of Brent and Harrow.
All patients contacting a doctor at either service in an eight week period beginning 1 September 1995.
Patients' age and sex; rates of home visiting, telephone advice, and attendance at a primary centre; hospital admission rates; prescribing rates; times of patient cells; and response times.
Data were collected on 5812 patient contacts. Doctors from the cooperative visited 32.0% (1253/ 3920) of patients, offered telephone advice to 57.8% (2267), and saw 7.1% (278) of patients at the primary care centre. By contrast, the deputising service visited 76.3% (1444/1892) of patients and gave telephone advice to 19.3% (365). Doctors from the cooperative prescribed drugs to fewer patients (37.6%; 1473/3915) than did the deputising service (51.7%; 941/1821) (odds ratio 0.56 (95% confidence interval 0.50 to 0.63) adjusted for age and sex) and admitted 8.7% (339/ 3888) of patients to hospital compared with 6.8% (128/1889) from the deputising service (odds ratio 1.30 (1.05 to 1.61) adjusted for age and sex). Response times for the deputising service were faster (median time to visit 65 minutes) than for the cooperative (median time to visit 75 minutes) but the time to first contact with a doctor was shorter for the cooperative because most people initially received telephone advice.
The cooperative in this study dealt with patient contacts very differently from the way the deputising service dealt with contacts, fewer patients being visited and fewer receiving prescriptions. The data presented enable other out of hours services to compare their own performance using a standard data collection and analysis program.
评估非工作时间全科医生合作组织与代理服务的情况。
对重叠地理区域内的两种服务进行观察性研究。
肯辛顿、切尔西和威斯敏斯特的一个全科医生合作组织以及在该地区和邻近的布伦特及哈罗地区运营的代理服务机构。
1995年9月1日开始的八周内联系过这两种服务中任何一种的所有患者。
患者的年龄和性别；上门出诊率、电话咨询率和在初级医疗中心就诊率；住院率；处方开具率；患者就诊时间；以及响应时间。
收集了5812次患者就诊的数据。合作组织的医生上门出诊的患者占32.0%（1253/3920），提供电话咨询的患者占57.8%（2267），在初级医疗中心接诊的患者占7.1%（278）。相比之下，代理服务机构上门出诊的患者占76.3%（1444/1892），提供电话咨询的患者占19.3%（365）。合作组织的医生给患者开药的比例（37.6%；1473/3915）低于代理服务机构（51.7%；941/1821）（经年龄和性别调整后的优势比为0.56（95%置信区间0.50至0.63）），合作组织将8.7%（339/3888）的患者收治入院，而代理服务机构为6.8%（128/1889）（经年龄和性别调整后的优势比为1.30（1.05至1.61））。代理服务机构的响应时间更快（上门出诊的中位时间为65分钟），而合作组织的响应时间较慢（上门出诊的中位时间为75分钟），但合作组织的首次联系医生时间较短，因为大多数人最初接受的是电话咨询。
本研究中的合作组织处理患者就诊的方式与代理服务机构有很大不同，上门出诊的患者较少，开具处方的患者也较少。所呈现的数据使其他非工作时间服务能够使用标准的数据收集和分析程序来比较自身表现。
