谢菲尔德的专科门诊服务：为实行基金持有制的全科医生的患者提供更快的门诊服务层级？

Department of Public Health, Rotherham Health Authority.

J Public Health Med. 1997 Sep;19(3):347-53. doi: 10.1093/oxfordjournals.pubmed.a024642.

BACKGROUND

Little is known about the activity of the many new specialist outreach clinics in fundholding general practices that have emerged since the introduction of fundholding in 1991, though it has been claimed that specialist outreach clinics have shortened waiting times for fundholders' patients. This study describes the activity of specialist outreach clinics in fundholding practices in Sheffield, focusing on comparative waiting times between fundholding and non-fundholding practices.

METHODS

A descriptive study was carried out using routine out-patient activity data and a listing of outreach clinics obtained from fundholding practices.

RESULTS

Thirty-seven specialist outreach clinics were established in fundholding practices by November 1994; 23 in surgical specialties. In 1994-1995, for gynaecology, orthopaedics and general surgery, the leading outreach specialties, 22.5 per cent of fundholders' first attendances were in outreach clinics. In those three specialties, 87.0 per cent of patients in specialist outreach clinics in fundholding practices vs 67.1 per cent in hospital clinics were routine appointments, and 17.4 per cent vs 9.4 per cent, respectively, were added to an in-patient waiting list. The proportion of first attendees seen in less than three months was 97.0 per cent in specialist outreach clinics in fundholding practices vs 88.1 per cent in hospital clinics; 90.4 per cent for the patients of fundholders who had outreach clinics vs 85.2 per cent for fundholders who did not; 88.1 per cent for all fundholders' patients vs 88.6 per cent for non-fundholders' patients.

CONCLUSIONS

The new specialist outreach service in fundholding practices in Sheffield is largely for surgical patients classified as routine patients. Although patients were seen more quickly in specialist outreach clinics, no overall inequality of waiting times between fundholding and non-fundholding practices was shown.

背景

自1991年实行基金持有制以来，许多新的专科门诊在实行基金持有制的全科医疗中开展，但人们对其活动了解甚少，尽管有人声称专科门诊缩短了基金持有者患者的等待时间。本研究描述了谢菲尔德实行基金持有制的医疗机构中专科门诊的活动情况，重点比较了实行基金持有制和未实行基金持有制的医疗机构之间的等待时间。

方法

利用常规门诊活动数据和从实行基金持有制的医疗机构获得的门诊清单进行描述性研究。

结果

到1994年11月，实行基金持有制的医疗机构设立了37个专科门诊；其中23个属于外科专科。在1994 - 1995年，对于妇科、骨科和普通外科这几个主要的门诊专科，基金持有者首次就诊的患者中有22.5%在门诊就诊。在这三个专科中，实行基金持有制的医疗机构的专科门诊中87.0%的患者是常规预约，而医院门诊中这一比例为67.1%；分别有17.4%和9.4%的患者被列入住院等待名单。在实行基金持有制的医疗机构的专科门诊中，不到三个月内就诊的首次就诊患者比例为97.0%，而医院门诊为88.1%；有门诊的基金持有者的患者这一比例为90.4%，没有门诊的基金持有者的患者为85.2%；所有基金持有者的患者这一比例为88.1%，非基金持有者的患者为88.6%。