PDF(Pubmed)
Abstract：
OBJECTIVE: In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met.
METHODS: This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection.
RESULTS: Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care.
CONCLUSIONS: Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.
METHODS: This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection.
RESULTS: Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care.
CONCLUSIONS: Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.
摘要：
目标：2018年，NHS英格兰规定，英格兰的所有患者都应能够在正常时间以外获得全科医生服务。虽然有些患者会在自己的实践中获得额外的时间，其他人将需要超实践级别的规定-也就是说，他们会在不同的地点和不同的护理团队看到。这项政策的目的是增加病人获得护理的机会，特别关注白天工作的人。这项研究检查了（a）如何实施超实践级别的针对一般医疗问题的延长访问任命的规定，以及（b）是否实现了该政策的目标。
方法：本研究提供了两个提供扩展访问的对比服务提供商的定性比较案例研究。收集的数据包括30小时的临床医生-患者观察，对员工的25次采访，经理,和委员们，20例患者访谈,组织协议/文档，并定期收集预约数据。专题分析与数据收集同时进行，并促进了数据收集的迭代调整。
结果：确定了三个交叉主题：扩展访问被用来支持陷入困境的初级保健系统，扩展访问提供了与工作时间一般实践不同的服务，并且很难提供无缝的护理。
结论：Supra-practiceaccessmodelscanprovideeffectivecareformostpatientswithstrainlyissues.当需要对复杂问题进行持续管理时，这种病人护理模式可能会有问题。
方法：本研究提供了两个提供扩展访问的对比服务提供商的定性比较案例研究。收集的数据包括30小时的临床医生-患者观察，对员工的25次采访，经理,和委员们，20例患者访谈,组织协议/文档，并定期收集预约数据。专题分析与数据收集同时进行，并促进了数据收集的迭代调整。
结果：确定了三个交叉主题：扩展访问被用来支持陷入困境的初级保健系统，扩展访问提供了与工作时间一般实践不同的服务，并且很难提供无缝的护理。
结论：Supra-practiceaccessmodelscanprovideeffectivecareformostpatientswithstrainlyissues.当需要对复杂问题进行持续管理时，这种病人护理模式可能会有问题。
