国民医疗服务体系(NHS)国家扩展准入计划是否实现了其政策目标?两个大型扩展访问提供商的案例研究。

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES
Patrick Burch, William Whittaker, Peter Bower, Katherine Checkland
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引用次数: 0

摘要

目标:2018年,英国国家医疗服务体系规定,英国所有患者都应该能够在正常时间以外获得全科医疗服务。虽然有些病人可以在自己的诊所获得额外的时间,但其他人则需要超诊所级别的服务——也就是说,他们将在不同的地点接受不同的护理团队的治疗。该政策的目的是增加病人获得护理的机会,特别关注那些白天工作的人。本研究考察了(a)如何在超实践层面为一般医疗问题提供延长就诊预约,以及(b)政策的目标是否正在实现。方法:本研究提出了定性比较案例研究两种截然不同的服务提供商提供扩展访问。收集的数据包括30小时的临床患者观察,25次对工作人员、管理人员和专员的访谈,20次对患者的访谈,组织协议/文件,以及常规收集的预约数据。专题分析与数据收集同时进行,促进了数据收集的反复调整。结果:确定了三个交叉主题:扩大可及性正在被用来支持挣扎中的初级保健系统,扩大可及性提供了不同于小时全科医生的服务,扩大可及性很难提供无缝护理。结论:超实践访问模式可为大多数直接问题患者提供有效的护理。当需要对复杂问题进行持续管理时,这种患者护理模式可能会出现问题。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers.

Objectives: In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met.

Methods: This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection.

Results: Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care.

Conclusions: Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.

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来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
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