PDF(Pubmed)
Abstract：
BACKGROUND: System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear.
OBJECTIVE: To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice.
METHODS: Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England.
METHODS: Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median.
RESULTS: Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients\' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms.
CONCLUSIONS: This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.
OBJECTIVE: To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice.
METHODS: Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England.
METHODS: Between February and October 2021, two modified Delphi exercises were conducted online: one with NHS GPs, and a subsequent exercise with patients. Over two rounds, GPs rated the importance of a list of operational failures (n = 45) that had been compiled using existing evidence. The resulting shortlist was presented to patients for rating over two rounds. Data were analysed using median scores and interquartile ranges. Consensus was defined as 80% of responses falling within one value below and above the median.
RESULTS: Sixty-two GPs responded to the first Delphi exercise, and 53.2% (n = 33) were retained through to round two. This exercise yielded consensus on 14 failures as a priority for improvement, which were presented to patients. Thirty-seven patients responded to the first patient Delphi exercise, and 89.2% (n = 33) were retained through to round two. Patients identified 13 failures as priorities. The highest scoring failures included inaccuracies in patients\' medical notes, missing test results, and difficulties referring patients to other providers because of problems with referral forms.
CONCLUSIONS: This study identified the highest-priority operational failures in general practice according to GPs and patients, and indicates where improvement efforts relating to operational failures in general practice should be focused.
摘要：
背景：系统问题，称为操作故障，会极大地影响全科医生的工作，对患者和专业经验产生负面影响，效率,和有效性。许多操作故障易于改进，但是应该优先考虑哪些是不太清楚的。
目的：在全科医生和患者之间就应优先考虑的操作失败达成共识，以改善NHS的一般实践。
方法：在英国几个地区的NHSGP和患者中进行了两次改良的Delphi练习。
方法：在2021年2月至10月之间，在线进行了两次改良的Delphi练习：一次与NHSGP进行，以及随后与患者的锻炼。经过两轮，GP对使用现有证据编制的运行故障列表（n=45）的重要性进行了评级。最终的入围名单被提交给患者，以进行两轮评级。使用中位数得分和四分位数范围分析数据。共识被定义为80%的响应落在一个低于和高于中位数的值内。
结果：62名全科医生对第一次德尔菲练习做出了回应，53.2%(n=33)保留到第二轮。这项工作就14个失败达成了共识，作为改进的优先事项，提供给患者。37名患者对第一名患者Delphi锻炼做出了反应，89.2%(n=33)保留到第二轮。患者将13个失败确定为优先事项。得分最高的失败包括病人的医疗记录不准确，缺少测试结果，以及由于转诊表格的问题而难以将患者转诊给其他提供者。
结论：本研究根据全科医生和患者确定了一般实践中最优先的操作故障，并指出应将与一般实践中的操作故障相关的改进工作集中在何处。
目的：在全科医生和患者之间就应优先考虑的操作失败达成共识，以改善NHS的一般实践。
方法：在英国几个地区的NHSGP和患者中进行了两次改良的Delphi练习。
方法：在2021年2月至10月之间，在线进行了两次改良的Delphi练习：一次与NHSGP进行，以及随后与患者的锻炼。经过两轮，GP对使用现有证据编制的运行故障列表（n=45）的重要性进行了评级。最终的入围名单被提交给患者，以进行两轮评级。使用中位数得分和四分位数范围分析数据。共识被定义为80%的响应落在一个低于和高于中位数的值内。
结果：62名全科医生对第一次德尔菲练习做出了回应，53.2%(n=33)保留到第二轮。这项工作就14个失败达成了共识，作为改进的优先事项，提供给患者。37名患者对第一名患者Delphi锻炼做出了反应，89.2%(n=33)保留到第二轮。患者将13个失败确定为优先事项。得分最高的失败包括病人的医疗记录不准确，缺少测试结果，以及由于转诊表格的问题而难以将患者转诊给其他提供者。
结论：本研究根据全科医生和患者确定了一般实践中最优先的操作故障，并指出应将与一般实践中的操作故障相关的改进工作集中在何处。
