PDF(Pubmed)
Abstract：
BACKGROUND: The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities.
OBJECTIVE: To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland.
METHODS: In 2022, a postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days was undertaken.
METHODS: Patient characteristics and consultation experiences in the three areas (DU, AU, RR) were evaluated using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI).
RESULTS: In total, 1053 responses were received. In DU areas, multimorbidity was more common (78% versus 58% AU versus 68% RR, P<0.01), complex presentations (where the consultation addressed both psychosocial and physical problems) were more likely (16% versus 10% AU versus 11% RR, P<0.05), and more consultations were conducted by telephone (42% versus 31% AU versus 31% RR, P<0.01). Patients in DU areas reported lower satisfaction (82% DU completely, very, or fairly satisfied versus 90% AU versus 86% RR, P<0.01), lower perceived GP empathy (mean CARE score 38.9 versus 42.1 AU versus 40.1 RR, P<0.05), lower enablement (mean PEI score 2.6 versus 3.2 AU versus 2.8 RR, P<0.01), and less symptom improvement (P<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement, and perceived GP empathy than telephone consultations in RR areas (all P<0.05).
CONCLUSIONS: Four years after the start of the new GP contract in Scotland, patients\' experiences of GP consultations suggest that the inverse care law persists.
OBJECTIVE: To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland.
METHODS: In 2022, a postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days was undertaken.
METHODS: Patient characteristics and consultation experiences in the three areas (DU, AU, RR) were evaluated using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI).
RESULTS: In total, 1053 responses were received. In DU areas, multimorbidity was more common (78% versus 58% AU versus 68% RR, P<0.01), complex presentations (where the consultation addressed both psychosocial and physical problems) were more likely (16% versus 10% AU versus 11% RR, P<0.05), and more consultations were conducted by telephone (42% versus 31% AU versus 31% RR, P<0.01). Patients in DU areas reported lower satisfaction (82% DU completely, very, or fairly satisfied versus 90% AU versus 86% RR, P<0.01), lower perceived GP empathy (mean CARE score 38.9 versus 42.1 AU versus 40.1 RR, P<0.05), lower enablement (mean PEI score 2.6 versus 3.2 AU versus 2.8 RR, P<0.01), and less symptom improvement (P<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement, and perceived GP empathy than telephone consultations in RR areas (all P<0.05).
CONCLUSIONS: Four years after the start of the new GP contract in Scotland, patients\' experiences of GP consultations suggest that the inverse care law persists.
摘要：
背景：新的苏格兰GP合同于2018年4月开始，其既定目标是减轻健康不平等。
目的：为了确定在贫困城市（DU）咨询全科医生的患者的健康特征和经验，富裕城市(AU)，以及苏格兰的偏远和农村(RR)地区。
方法：2022年，对12名在过去30天内咨询过全科医生的成年患者进行了随机抽样调查。
方法：这三个领域的患者特征和咨询经验（DU，AU,RR）使用经过验证的措施进行评估，包括咨询和关系共情（CARE）措施和患者支持工具（PEI）。
结果：总计，收到1053份答复。在DU地区，多发病率更常见(78%对58%AU对68%RR，P<0.01),复杂的陈述(咨询解决了心理社会和身体问题)更有可能(16%对10%AU对11%RR，P<0.05),更多的咨询通过电话进行(42%对31%AU对31%RR，P<0.01)。DU地区的患者报告满意度较低(82%DU完全，非常,或相当满意，相对于90%的AU和86%的RR，P<0.01),较低的全科医生同理心(平均护理分数38.9对42.1AU对40.1RR，P<0.05),较低的启用(平均PEI得分为2.6和3.2AU和2.8RR，P<0.01),症状改善少于AU或RR区（P<0.01）。面对面的咨询与满意度明显更高相关，启用，在RR地区，感觉到GP的同理心高于电话咨询（均P<0.05）。
结论：苏格兰新GP合同开始四年后，患者的全科医生咨询经验表明，反向护理法仍然存在。
目的：为了确定在贫困城市（DU）咨询全科医生的患者的健康特征和经验，富裕城市(AU)，以及苏格兰的偏远和农村(RR)地区。
方法：2022年，对12名在过去30天内咨询过全科医生的成年患者进行了随机抽样调查。
方法：这三个领域的患者特征和咨询经验（DU，AU,RR）使用经过验证的措施进行评估，包括咨询和关系共情（CARE）措施和患者支持工具（PEI）。
结果：总计，收到1053份答复。在DU地区，多发病率更常见(78%对58%AU对68%RR，P<0.01),复杂的陈述(咨询解决了心理社会和身体问题)更有可能(16%对10%AU对11%RR，P<0.05),更多的咨询通过电话进行(42%对31%AU对31%RR，P<0.01)。DU地区的患者报告满意度较低(82%DU完全，非常,或相当满意，相对于90%的AU和86%的RR，P<0.01),较低的全科医生同理心(平均护理分数38.9对42.1AU对40.1RR，P<0.05),较低的启用(平均PEI得分为2.6和3.2AU和2.8RR，P<0.01),症状改善少于AU或RR区（P<0.01）。面对面的咨询与满意度明显更高相关，启用，在RR地区，感觉到GP的同理心高于电话咨询（均P<0.05）。
结论：苏格兰新GP合同开始四年后，患者的全科医生咨询经验表明，反向护理法仍然存在。
