Public experiences of service change in primary care: Focusing on the spaces and places of service delivery

初级保健服务变革的公众体验：关注服务提供的空间和场所

• 批准号: 2876868
• 金额: --
• 依托单位: Lancaster University
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2023
• 资助国家: 英国
• 起止时间: 2023 至 无数据
• 项目状态: 未结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2876868
• 关键词: Public; experiences; service; change; primary

This project focuses on understanding how transforming primary care provision is perceived andexperienced by the public.In the context of high proportions of clinically unnecessary attendances at A&E, understanding whypatients make decisions to access emergency services is important to inform interventions thatreduce overloaded primary care provision. The proposed research explores the motivatingconditions and sense-making activities that influence patients' attendances and experiences atprimary care sites. The project will also examine how patients' situated encounters with primarycare services shape perceptions of local health policy amongst a wider backdrop of systemicchanges to primary care provision.One of the most ambitious plans of the National Health Service (NHS) is to 'transform primary care'(NHS, 2021). The impetus for this transformation is to enable the NHS to continue to meet provisionrequirements in response to escalating public demand and financial pressures, ensuring patientswith diverse needs are met with a choice of offerings. Notable initiatives include: the non emergency "111 First" helpline, the "Pharmacy First" minor ailments campaign, and the "AskMyGP"online consultation platform, all introduced to achieve greater workforce utilisation, offset hospitalattendance, and provide more accessible care at lower cost.Clinically unnecessary attendances at A&E are a concern. Recent reports suggest they account forup to 40% of presentations at A&E, with approximately 11% of patients discharged withouttreatment (NHS Digital, 2017). A recent review of patients' unnecessary use of emergency servicespresents a complex situation, linked to patient frustrations with attempts to obtain a GPappointment, coupled with perceptions that A&E attendance is a lower effort, less risky and swifterway of receiving treatment (O'Caithin et al, 2019). There is evidence of higher rates of unnecessaryattendance by certain groups (children aged <5, adults aged >65, women, those fromsocioeconomically deprived areas, with chronic diseases or mental health problems), suggestingissues of health equity (Foster et al, 2020).

这个项目的重点是了解公众如何感知和体验初级保健服务的转变。在临床上不必要的急诊室就诊比例很高的情况下，了解患者决定获得紧急服务对于减少初级保健服务超载的干预措施非常重要。这项拟议的研究探索了影响患者在初级保健地点就诊和体验的动机条件和意义形成活动。该项目还将研究患者与初级保健服务的遭遇如何在初级保健服务发生系统性变化的更广泛背景下塑造对当地卫生政策的看法。国民保健服务(NHS)最雄心勃勃的计划之一是“改变初级保健”(NHS，2021)。这一转变的动力是使NHS能够继续满足不断增长的公共需求和财政压力的供应要求，确保满足具有不同需求的患者的服务选择。值得注意的措施包括：非紧急求助热线“111优先”、“药房优先”小病运动，以及“AskMyGP”网上咨询平台，所有这些措施都是为了实现更高的劳动力利用率、减少住院次数，并以更低的成本提供更容易获得的医疗服务。最近的报告表明，他们占急诊报告的40%，大约11%的患者在没有治疗的情况下出院(NHS Digital，2017)。最近一项对患者不必要地使用急救服务的审查显示了一个复杂的情况，与患者对尝试获得全科医生预约的挫折感有关，以及人们认为急诊室就诊是一种较低的努力、较低的风险和接受治疗的快捷方式(O‘Caithing等人，2019年)。有证据表明，某些群体(5岁的儿童、65岁的成年人、妇女、来自社会经济贫困地区的人、患有慢性病或精神健康问题的人)的不必要就诊率较高，这表明健康公平问题(Foster等人，2020年)。