单手与多手综合实践:英格兰质量成果横断面研究。

IF 1.9 4区 医学 Q3 HEALTH POLICY & SERVICES Journal of Health Services Research & Policy Pub Date : 2024-07-01 Epub Date: 2023-12-13 DOI:10.1177/13558196231218830
Ian Holdroyd, William Chadwick, Adam Harvey-Sullivan, Theodore Bartholomew, Efthalia Massou, Victoria Tzortziou Brown, John Ford
{"title":"单手与多手综合实践:英格兰质量成果横断面研究。","authors":"Ian Holdroyd, William Chadwick, Adam Harvey-Sullivan, Theodore Bartholomew, Efthalia Massou, Victoria Tzortziou Brown, John Ford","doi":"10.1177/13558196231218830","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK.</p><p><strong>Methods: </strong>Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices.</p><p><strong>Results: </strong>Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes.</p><p><strong>Conclusions: </strong>We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.</p>","PeriodicalId":15953,"journal":{"name":"Journal of Health Services Research & Policy","volume":" ","pages":"201-209"},"PeriodicalIF":1.9000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151703/pdf/","citationCount":"0","resultStr":"{\"title\":\"Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.\",\"authors\":\"Ian Holdroyd, William Chadwick, Adam Harvey-Sullivan, Theodore Bartholomew, Efthalia Massou, Victoria Tzortziou Brown, John Ford\",\"doi\":\"10.1177/13558196231218830\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK.</p><p><strong>Methods: </strong>Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices.</p><p><strong>Results: </strong>Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes.</p><p><strong>Conclusions: </strong>We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.</p>\",\"PeriodicalId\":15953,\"journal\":{\"name\":\"Journal of Health Services Research & Policy\",\"volume\":\" \",\"pages\":\"201-209\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151703/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Health Services Research & Policy\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1177/13558196231218830\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2023/12/13 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"HEALTH POLICY & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Services Research & Policy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/13558196231218830","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/12/13 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0

摘要

目的:随着全科医生越来越多地转向大型团体诊所,人们对不同医疗服务模式的相对益处、安全性和可持续性展开了争论。本研究调查了英国英格兰单人执业与多人执业的绩效比较:方法:研究对象包括英格兰拥有超过 1000 名患者的医疗机构。劳动力数据和质量控制程序将诊所分为单手诊所和多手诊所。研究结果包括:(i) 对全科医生患者的调查评分,衡量其就诊情况、就诊连续性、对医疗专业人员的信心以及总体满意度;(ii) 糖尿病和高血压的报告结果;(iii) 急诊科就诊率和癌症检测率(2周等待后确诊的癌症百分比)。在控制患者和医疗机构特征的基础上,通过广义线性模型比较了单手和多手医疗机构的结果,并评估了单手医疗机构中全科医生年龄的影响:结果:单手执业更常见于高度贫困地区(41%,而多手执业仅为 20%)。单手执业医生在患者报告的就诊率、连续性和总体满意度方面较高,但糖尿病管理率和癌症检出率略低。如果控制了单手诊疗所的患者特征,急诊室就诊率会更高,但如果同时控制了诊疗所的乡村化程度和规模,就不会出现这种情况。贫困程度的增加与八项结果中七项结果的较低绩效有关:我们发现,单手执业的患者满意度较高,但在选定的临床结果方面表现稍差。要更好地了解诊所规模(包括增加多学科合作)与患者体验和治疗效果之间的关系,还需要进一步的研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England.

Objectives: As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK.

Methods: Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices.

Results: Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes.

Conclusions: We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.

求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
CiteScore
4.40
自引率
4.20%
发文量
39
期刊介绍: Journal of Health Services Research & Policy provides a unique opportunity to explore the ideas, policies and decisions shaping health services throughout the world. Edited and peer-reviewed by experts in the field and with a high academic standard and multidisciplinary approach, readers will gain a greater understanding of the current issues in healthcare policy and research. The journal"s strong international editorial advisory board also ensures that readers obtain a truly global and insightful perspective.
期刊最新文献
Health care utilization and costs among coordinated care patients in Southeastern Ontario: A difference-in-differences study of a double propensity score-matched cohort. The role of collaborative governance in translating national cancer programs into network-based practices: A longitudinal case study in Canada. How can specialist investigation agencies inform system-wide learning for patient safety? A qualitative study of perspectives on the early years of the English healthcare safety investigation branch. What can the era of big data and big data analytics mean for health services research? Collaborative and integrated working between general practice and community pharmacies: A realist review of what works, for whom, and in which contexts.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1