PDF(Pubmed)
Abstract：
BACKGROUND: Despite longstanding problems of access to general practice, attempts to understand and address the issues do not adequately include perspectives of the people providing or using care, nor do they use established theories of access to understand complexity.
OBJECTIVE: To understand problems of access to general practice from the multiple perspectives of service users and staff using an applied theory of access.
METHODS: A qualitative participatory case study in an area of northwest England.
METHODS: A community-based participatory approach was used with qualitative interviews, focus groups, and observation to understand perspectives about accessing general practice. Data were collected between October 2015 and October 2016. Inductive and abductive analysis, informed by Levesque et al\'s theory of access, allowed the team to identify complexities and relationships between interrelated problems.
RESULTS: This study presents a paradox of problems in accessing general practice, in which the demand on general practice both creates and hides unmet need in the population. Data show how reactive rules to control demand have undermined important aspects of care, such as continuity. The layers of rules and decreased continuity create extra work for practice staff, clinicians, and patients. Complicated rules, combined with a lack of capacity to reach out or be flexible, leave many patients, including those with complex and/or unrecognised health needs, unable to navigate the system to access care. This relationship between demand and unmet need exacerbates existing health inequities.
CONCLUSIONS: Understanding the paradox of access problems allows for different targets for change and different solutions to free up capacity in general practice to address the unmet need in the population.
OBJECTIVE: To understand problems of access to general practice from the multiple perspectives of service users and staff using an applied theory of access.
METHODS: A qualitative participatory case study in an area of northwest England.
METHODS: A community-based participatory approach was used with qualitative interviews, focus groups, and observation to understand perspectives about accessing general practice. Data were collected between October 2015 and October 2016. Inductive and abductive analysis, informed by Levesque et al\'s theory of access, allowed the team to identify complexities and relationships between interrelated problems.
RESULTS: This study presents a paradox of problems in accessing general practice, in which the demand on general practice both creates and hides unmet need in the population. Data show how reactive rules to control demand have undermined important aspects of care, such as continuity. The layers of rules and decreased continuity create extra work for practice staff, clinicians, and patients. Complicated rules, combined with a lack of capacity to reach out or be flexible, leave many patients, including those with complex and/or unrecognised health needs, unable to navigate the system to access care. This relationship between demand and unmet need exacerbates existing health inequities.
CONCLUSIONS: Understanding the paradox of access problems allows for different targets for change and different solutions to free up capacity in general practice to address the unmet need in the population.
摘要：
背景：尽管获得一般实践的长期问题，试图理解和解决这些问题并没有充分包括提供或使用护理的人的观点，他们也不使用既定的获取理论来理解复杂性。
目的：使用应用访问理论，从服务用户和员工的多个角度了解访问一般实践的问题。
方法：英格兰西北部地区的定性参与式案例研究。
方法：定性访谈采用了基于社区的参与式方法，焦点小组,和观察，以了解有关访问一般实践的观点。数据收集时间为2015年10月至2016年10月。归纳和归纳分析，在Levesque等人的准入理论的指导下，允许团队识别相互关联的问题之间的复杂性和关系。
结果：这项研究提出了一个悖论，在这种情况下，对一般做法的需求既创造又隐藏了人口中未满足的需求。数据显示，控制需求的反应性规则如何破坏了护理的重要方面，比如连续性。层层的规则和减少的连续性为实践人员创造了额外的工作，临床医生,和病人。复杂的规则,加上缺乏伸出手或灵活性的能力，留下许多病人，包括那些有复杂和/或未被确认的健康需求的人，无法导航系统以访问护理。需求与未满足的需求之间的这种关系加剧了现有的健康不平等。
结论：了解访问问题的悖论可以实现不同的变化目标和不同的解决方案，以释放一般实践中的容量，以解决人口中未满足的需求。
目的：使用应用访问理论，从服务用户和员工的多个角度了解访问一般实践的问题。
方法：英格兰西北部地区的定性参与式案例研究。
方法：定性访谈采用了基于社区的参与式方法，焦点小组,和观察，以了解有关访问一般实践的观点。数据收集时间为2015年10月至2016年10月。归纳和归纳分析，在Levesque等人的准入理论的指导下，允许团队识别相互关联的问题之间的复杂性和关系。
结果：这项研究提出了一个悖论，在这种情况下，对一般做法的需求既创造又隐藏了人口中未满足的需求。数据显示，控制需求的反应性规则如何破坏了护理的重要方面，比如连续性。层层的规则和减少的连续性为实践人员创造了额外的工作，临床医生,和病人。复杂的规则,加上缺乏伸出手或灵活性的能力，留下许多病人，包括那些有复杂和/或未被确认的健康需求的人，无法导航系统以访问护理。需求与未满足的需求之间的这种关系加剧了现有的健康不平等。
结论：了解访问问题的悖论可以实现不同的变化目标和不同的解决方案，以释放一般实践中的容量，以解决人口中未满足的需求。
