Practice features associated with patient-reported accessibility, continuity, and coordination of primary health care
Practice features associated with patient-reported accessibility, continuity, and coordination of primary health care
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DOI：
10.1370/afm.802
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发表时间：
2008-03-01
影响因子：
4.4
通讯作者：
Rodrigue, Jean
中科院分区：
文献类型：
--
作者：
Haggerty, Jeannie L.;Pineault, Raynald;Rodrigue, Jean
在主要的初级卫生保健改革的前夕，我们进行了一个多层次的调查，初级卫生保健诊所，以确定属性的诊所组织和医生的做法，预测可及性，连续性和协调的护理作为experiencedbypatient.METHODS初级卫生保健诊所分层随机抽样在城市，郊区，农村和偏远地区在魁北克，加拿大。每个诊所最多选择4名家庭医生或全科医生，每位医生就诊的20名患者使用初级保健评估工具报告首次接触的可及性（能够在突发疾病时迅速获得护理），关系连续性（与了解其详情的医生保持持续关系）和协调连续性（医生与专家之间的协调）。医生报告了他们的实践方面，秘书和主任报告了诊所的组织特征。我们使用分层回归模型的子样本的常规患者在clinic.Results一百诊所参与（61%的响应率），为221名医生和2,725名普通患者（87%的响应和完成率）。第一次接触的可及性是最成问题的。在拥有10名或10名以下医生、1名护士、每周7天每天24小时提供电话服务、与其他保健机构签订业务协议以便利护理以及夜间无预约服务的诊所，这种可及性更好。业务协议和夜间护理也积极影响关系的连续性。重视连续性并感到与社区有联系的医生培养了更好的关系连续性，而以可及性为导向的风格协调的连续性也与更多的业务协议和持续的电话联系有关，当医生在医院兼职并在办公室进行更大范围的医疗程序时，情况更好。结论：诊所的组织方式允许医生实现这两个目标可访问性和连续性，而不是其中之一。实现这两个目标的特点是提供夜间护理和电话咨询，并与其他保健机构签订业务协议。
PURPOSE on the eve of major primary health care reforms, we conducted a multilevel survey of primary health care clinics to identify attributes of clinic organization and physician practice that predict accessibility, continuity, and coordination of care as experienced by patients.METHODS Primary health care clinics were selected by stratified random sampling in urban, suburban, rural, and remote locations in Quebec, Canada. Up to 4 family or general physicians were selected in each clinic, and 20 patients seeing each physician used the Primary Care Assessment Tool to report on first-contact accessibility (being able to obtain care promptly for sudden illness), relational continuity (having an ongoing relationship with a physician who knew their particulars), and coordination continuity (having coordination between their physician and specialists). Physicians reported on aspects of their practice, and secretaries and directors reported on organizational features of the clinic. We used hierarchical regression modeling on the subsample of regular patients at the clinic.RESULTS One hundred clinics participated (61% response rate), for a total of 221 physicians and 2,725 regular patients (87% response and completion rate). First-contact accessibility was most problematic. Such accessibility was better in clinics with 10 or fewer physicians, a nurse, telephone access 24 hours a day and 7 days a week, operational agreements to facilitate care with other health care establishments, and evening walk-in services. Operational agreements and evening care also positively affected relational continuity. Physicians who valued continuity and felt attached to the community fostered better relational continuity, whereas an accessibility-oriented style (as indicated by a high proportion of walk-in care and high patient volume) hindered it. Coordination continuity was also associated with more operational agreements and continuous telephone access, and was better when physicians practiced part time in hospitals and performed a larger range of medical procedures in their office.CONCLUSIONS The way a clinic is organized allows physicians to achieve both accessibility and continuity rather than one or the other. Features that achieve both are offering care in the evenings and access to telephone advice, and having operational agreements with other health care establishments.