Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study
Influence of general practice opening hours on delay in seeking medical attention after transient ischaemic attack (TIA) and minor stroke: prospective population based study
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DOI：
10.1136/bmj.a1569
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发表时间：
2008-10-04
影响因子：
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通讯作者：
Rothwell, Peter M.
中科院分区：
文献类型：
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作者：
Lasserson, Daniel S.;Chandratheva, Arvind;Rothwell, Peter M.
目的探讨全科开诊时间对短暂性脑缺血发作(TIA)和轻度卒中患者就医行为的影响及在发病后24小时内进行临床评估的可行性。设计基于人群的前瞻性发病率研究(牛津血管研究)。在牛津设立9项全科诊疗。参与者从2002年4月1日至2006年3月31日对91 000名患者进行跟踪调查。主要结果衡量发生在夜间和周末(非工作时间)的事件和发生在手术时间内的事件。结果在359例TIA患者和434例轻度卒中患者中，在手术时间内发生事件后打电话给全科医生的中位数(四分位数范围)为4.0(1.0-45.5)小时，68%在手术时间内发生事件的患者在症状出现后24小时内打电话。在非工作时间情况下，患者等待联系其注册医生的中位数(四分位数范围)呼叫全科医生的时间为24.8小时，而使用急诊全科医生服务的患者为1.0(0.3-2.6)小时(P<；0.001)。在等待看自己的全科医生的患者中，在周末的事件中，在24小时内寻求关注的可能性比平日低得多(优势比0.10，95%的可信区间为0.05至0.21)：周一至周五的事件为70%，周日为33%，周六为零。13名在非工作时间发生事件且没有寻求急救的患者在寻求医疗护理之前中风复发。一家一周七天上午8点至晚上8点开放的初级保健中心将覆盖73名等到手术时间才打电话给全科医生的患者，这一群体的中位延误从50.1小时减少到4.0小时，24小时内打电话的人从34%增加到68%。结论全科医生的开放时间影响了TIA和轻微中风后患者的求医行为。目前的开放时间可能会增加评估的延迟。如果要实现国家中风战略中的相关目标，就需要更好地获得初级保健和关于紧急护理必要性的公共教育。
Objective To assess the influence of general practice opening hours on healthcare seeking behaviour after transient ischaemic attack ( TIA) and minor stroke and feasibility of clinical assessment within 24 hours of symptom onset.Design Population based prospective incidence study ( Oxford vascular study).Setting Nine general practices in Oxfordshire.Participants 91 000 patients followed from 1 April 2002 to 31 March 2006.Main outcome measures Events that occurred overnight and at weekends ( out of hours) and events that occurred during surgery hours.Results Among 359 patients with TIA and 434 with minor stroke, the median ( interquartile range) timeto call a general practitioner after an event during surgery hours was 4.0 ( 1.0-45.5) hours, and 68% of patients with events during surgery hours called within 24 hours of onset of symptoms. Median ( interquartile range) time to call a general practitioner after events out of hours was 24.8 ( 9.0- 54.5) hours for patients who waited to contact their registered practice compared with 1.0 ( 0.3- 2.6) hour in those who used an emergency general practitioner service ( P< 0.001). In patients with events out of hours who waited to see their own general practitioner, seeking attention within 24 hours was considerably less likely for events at weekends than weekdays ( odds ratio 0.10, 95% confidence interval 0.05 to 0.21): 70% with events Monday to Friday, 33% on Sundays, and none on Saturdays. Thirteen patients who had events out of hours and did not seek emergency care had a recurrent stroke before they sought medical attention. A primary care centre open 8 am- 8 pm seven days a week would have offered cover to 73 patients who waited until surgery hours to call their general practitioner, reducing median delay from 50.1 hours to 4.0 hours in that group and increasing those calling within 24 hours from 34% to 68%.Conclusions General practitioners' opening hours influence patients' healthcare seeking behaviour after TIA and minor stroke. Current opening hours can increase delay in assessment. Improved access to primary care and public education about the need for emergency care are required if the relevant targets in the national stroke strategy are to be met.