An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?
An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?
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DOI：
10.1186/s12875-016-0484-1
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发表时间：
2016-07-21
影响因子：
2.9
通讯作者：
O'Shea, Brendan J.
中科院分区：
文献类型：
--
作者：
Barragry, Ruth A.;Varadkar, Leo E.;O'Shea, Brendan J.
背景：全科医疗合作社在爱尔兰的社区提供大部分非工作时间的护理。关于患者投诉的数据有限。本研究报告了基尔代尔和西威克洛随叫随到医生（“K Doc”）（爱尔兰的一家全科医生合作机构）的投诉，研究了实施的正式风险降低策略（2010-2013年）的影响。该研究的目的是确定是否有可能通过正式的方法来降低每1000次咨询的书面投诉率，包括评估投诉，改善与投诉相关的沟通，以及更直接地使用从投诉分析中获得的见解，以继续在合作社的专业发展。方法：最初，对18个月期间（2008年6月1日至2009年12月31日）提交的投诉进行了分析。记录投诉率（每1000次咨询的投诉数量）、投诉人人口统计数据、Co-Operative的投诉响应方面以及投诉性质。根据分析结果，采取了一项减少风险战略，包括改变程序、重点培训和教育。在数据收集的第二阶段，选择改进的领域包括投诉率、合作对投诉的及时性以及投诉通知患者全科医生的比率。然后在45个月的时间内（2010年1月1日至2013年9月30日）进行进一步分析。结果：从2008年至2013年，共发生216，716例患者咨询。收到了131名个人的投诉，涉及125名患者。在引入风险降低策略后，两个数据收集期之间的投诉率降低了36%，从0.77/1000次咨询降至0.49/1000次咨询（p = 0.02）。合作组织对投诉人的答复及时性从63%提高到75%。投诉通知患者的GP从48%提高到96%。大多数投诉与医学上重要的事件无关。最大的投诉类别涉及临床护理（55%，n = 69）、成本（46%，n = 58）、沟通（42%，n = 53）和护理过程（15%，n = 19）。富裕的儿科患者的母亲是最有可能作出正式的complaints.Conclusions：这项研究报告的投诉率为36%，在GP合作经营的风险降低策略引入统计学显着减少。众所周知，非工作时间咨询是一个高医疗风险领域。调查结果是感兴趣的地方，对全科医生的投诉的数量和成本据报在其他地方正在上升，导致医疗通货膨胀，并引起公众的关注。
Background: General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013). The aim of the study was to determine if it was possible to reduce the rate of written complaints per 1000 consultations through a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis in continuing professional development at the Co-Operative.Methods: Initially, complaints submitted over an 18 month period (01.06.08 to 31.12.09) were analysed. Complaint rate (number of complaints per 1000 consultations), complainant demographics, aspects of complaint response at the Co-Operative, and nature of complaint were recorded. Based on analysis, a risk reduction strategy was undertaken, including procedural change, focused training and education. Areas selected for improvement during a second phase of data collection included complaints rate, timeliness of Co-Operative response to complaint, and rate of complaint notification to patient's GP. Further analysis was then carried out over a 45 month period (01.01.10 to 30.09.13).Results: From 2008-2013, 216,716 patient consultations occurred. Complaints were received from 131 individuals, regarding 125 patients. Following introduction of risk reduction strategy, complaints rate reduced by 36 %, from 0.77 to 0.49 per 1000 consultations (p = 0.02) between the two periods of data collection. Timeliness of response from Co-Operative to the complainant improved from 63 % to 75 %. Notification of complaint to the patient's GP improved from 48 % to 96 %.Most complaints were not associated with medically significant events. The largest categories of complaint related to clinical care (55 % n = 69), cost (46 %, n = 58), communication (42 %, n = 53), and process of care (15 %, n = 19). Mothers of affluent paediatric patients were most likely to make formal complaints.Conclusions: This study reports a statistically significant reduction in complaints rate of 36 % following introduction of risk reduction strategies at a GP Co Operative. Out of hours consulting is known to be an area of high medical risk. Findings are of interest where number and costs of complaints against GPs are elsewhere reported to be rising, contributing to medical inflation, and to public concern.