Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14.
Clinical workload in UK primary care: a retrospective analysis of 100 million consultations in England, 2007-14.
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DOI：
10.1016/s0140-6736(16)00620-6
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发表时间：
2016-06-04
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通讯作者：
National Institute for Health Research School for Primary Care Research
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作者：
Hobbs FDR;Bankhead C;Mukhtar T;Stevens S;Perera-Salazar R;Holt T;Salisbury C;National Institute for Health Research School for Primary Care Research
初级保健是许多卫生系统（包括英国国家卫生服务体系）的主要保健来源，但关于初级保健活动的数量和性质的客观数据很少。随着越来越多的关注，国民保健服务的初级保健工作量大幅增加，我们的目的是评估全科医生（GP）和实践护士在英国的初级保健的直接临床工作量。我们对2007年4月至2014年3月期间在398家英国全科诊所登记的非临时患者的GP和护士咨询进行了回顾性分析。我们使用了来自电子健康记录的数据，这些数据常规地输入到临床实践研究数据链中，并将CPRD数据与国家数据集联系起来。年龄标准化和性别标准化的咨询率的趋势进行建模与联合点回归分析。该数据集包括101 818 352次咨询和20 626 297人-年的观察。 人均粗年就诊率增加了10.51%，从2007- 2008年的4.67增加到2013- 2014年的5.16。婴儿（0-4岁）和老年人（≥85岁）的就诊率最高，女性患者的就诊率高于所有年龄段的男性患者。年龄标准化和性别标准化比率的最大增幅是全科医生，每10000人年增加12.36%，而实习护士为0.9%。 全科医生的电话咨询率翻了一番，而占所有咨询90%的手术咨询增长了5.20%。GP手术会诊的平均持续时间增加了6.7%，从8.65分钟（95%CI 8.64 - 8.65）增加到9.22分钟（9.22 - 9.23），总体工作量增加了16%。我们的研究结果表明，在实践咨询率，平均咨询时间，并在英语全科医学面对的临床工作量的总患者大幅增加。这些结果表明，目前提供的英国初级保健可能达到饱和点。值得注意的是，我们的数据只探讨了直接的临床工作量，而不是间接的活动和专业职责，这可能也增加了。这一问题和其他研究问题，包括卫生保健其他部门工作量变化的结果，需要国际上提供初级保健的迫切答案。卫生政策研究计划部。
Primary care is the main source of health care in many health systems, including the UK National Health Service (NHS), but few objective data exist for the volume and nature of primary care activity. With rising concerns that NHS primary care workload has increased substantially, we aimed to assess the direct clinical workload of general practitioners (GPs) and practice nurses in primary care in the UK. We did a retrospective analysis of GP and nurse consultations of non-temporary patients registered at 398 English general practices between April, 2007, and March, 2014. We used data from electronic health records routinely entered in the Clinical Practice Research Datalink, and linked CPRD data to national datasets. Trends in age-standardised and sex-standardised consultation rates were modelled with joinpoint regression analysis. The dataset comprised 101 818 352 consultations and 20 626 297 person-years of observation. The crude annual consultation rate per person increased by 10·51%, from 4·67 in 2007–08, to 5·16 in 2013–14. Consultation rates were highest in infants (age 0–4 years) and elderly people (≥85 years), and were higher for female patients than for male patients of all ages. The greatest increases in age-standardised and sex-standardised rates were in GPs, with a rise of 12·36% per 10 000 person-years, compared with 0·9% for practice nurses. GP telephone consultation rates doubled, compared with a 5·20% rise in surgery consultations, which accounted for 90% of all consultations. The mean duration of GP surgery consultations increased by 6·7%, from 8·65 min (95% CI 8·64–8·65) to 9·22 min (9·22–9·23), and overall workload increased by 16%. Our findings show a substantial increase in practice consultation rates, average consultation duration, and total patient-facing clinical workload in English general practice. These results suggest that English primary care as currently delivered could be reaching saturation point. Notably, our data only explore direct clinical workload and not indirect activities and professional duties, which have probably also increased. This and additional research questions, including the outcomes of workload changes on other sectors of health care, need urgent answers for primary care provision internationally. Department of Health Policy Research Programme.