Hoult L
Department of Primary Care and Population Sciences, University College London Medical School, UK.
Fam Pract. 1998 Apr;15 Suppl 1:S30-5.
The reasons for the increase in demand for out-of-hours primary care are not clear.
We aimed to elicit the proportion of patients who call out-of-hours within 2 days of a GP consultation, and to explore the reasons for the out-of-hours call.
In one inner-city general practice, details were collected of all out-of-hours calls, over a 6-week period. Patients who called out-of-hours within 2 days of a GP consultation were identified and interviewed. Twenty semi-structured interviews were analysed using standard qualitative techniques.
Fifteen per cent of the out-of-hours calls occurred within 2 days of a GP consultation. The reasons for the calls recorded by the doctor out-of-hours and described by the patient at interview were similar. In two-thirds of cases the calls were related to the initial problem, but there was no evidence suggesting dissatisfaction with the first contact as a reason for the call. Less than a quarter of calls were for ongoing acute medical problems, and a quarter were about medication prescribed at the first consultation. A third of the patients had mental health problems with other physical, social and emotional problems. Many of this group were high users of this and other health services, including accident and emergency and private medicine. Some people called with specific queries or were seeking general information to enhance their understanding of illness.
This small study in one inner-city practice indicates that patients do not appear to call out-of-hours due to dissatisfaction with a previous consultation. There seems to be a wide variety of reasons why this pattern of service use occurs. The diversity of patients and problems and the prevalence of people with multiple problems highlights current challenges in inner-city primary health care.
非工作时间初级医疗需求增加的原因尚不清楚。
我们旨在确定在全科医生会诊后2天内拨打非工作时间电话的患者比例，并探究拨打非工作时间电话的原因。
在一个市中心的全科诊所，收集了6周内所有非工作时间电话的详细信息。确定并访谈了在全科医生会诊后2天内拨打非工作时间电话的患者。使用标准定性技术对20次半结构化访谈进行了分析。
15%的非工作时间电话是在全科医生会诊后2天内拨打的。非工作时间医生记录的电话原因与患者在访谈中描述的原因相似。在三分之二的病例中，电话与最初的问题有关，但没有证据表明对首次接触不满意是打电话的原因。不到四分之一的电话是关于持续的急性医疗问题，四分之一是关于首次会诊时开的药。三分之一的患者有心理健康问题以及其他身体、社会和情感问题。这组患者中的许多人是该医疗服务及其他医疗服务（包括急诊和私立医疗）的高使用者。一些人打电话是有具体疑问，或者是寻求一般信息以增进对疾病的了解。
这项在一个市中心诊所进行的小型研究表明，患者似乎并非因对之前的会诊不满意而拨打非工作时间电话。出现这种服务使用模式的原因似乎多种多样。患者和问题的多样性以及有多种问题的人群的普遍性凸显了市中心初级医疗保健当前面临的挑战。
