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背景自2000年以来,荷兰全科医生合作项目一直在提供工作时间外的初级保健服务。具有类似组织机构的国家的早期研究也说明了全科医生合作项目的正性经验。然而大家普遍认为在合作项目中全科医生经历了高负荷的工作量,外包成为他们工作的相当大的一部分。目的对全科医生在工作时间外提供初级保健服务的利与弊、频次及外包工作的理由进行了解。方法以网络问卷方式,对荷兰6个全科医生合作项目的 688名全科医生进行了横截面调查。结果问卷的回收率为55%(378/688)。全科医生合作项目工作的主要理由:作为全科医生要保持挂号(79%);处理急症经历(74%)。全科医生认为峰值工作量(81%)和患者数目众多(73%)为最负性的经历。大多数全科医生自己选择提供非工作时间的外包服务:85%的全科医生外包服务时间最高超过了他们工作时间的25%。外包服务比例随着年龄增长而上升。外包服务的主要理由是希望有更多的私人时间(76%);白天工作时间高工作负荷(71%);非工作时间低工作负荷(46%)。结论鼓励全科医生参加非工作时间的全科医生合作项目,减少外包工作。全科医生认为最负性的经历是峰值工作量及大数目(非急症)帮助需求。为了激励更多全科医生提供7 d×24 h的初级保健服务,对他们的工作负荷进行界定显得更为重要。
Background The Dutch GP program has been providing primary health care after work hours since 2000. Earlier studies from countries with similar organizations also illustrated positive experiences with GPs. However, it is generally accepted that GPs are experiencing a heavy workload in collaborative projects and that outsourcing has become a significant part of their work. Objectives To understand the pros and cons of GPs providing primary health care services outside working hours, frequency and reasons for outsourcing. Methods A cross-sectional survey was conducted on 688 general practitioners working in six Dutch GPs in a collaborative online survey. Results The questionnaire recovery rate was 55% (378/688). The main reasons for GP work include: keeping GP as a GP (79%); dealing with emergency (74%). GPs consider the peak workload (81%) and the large number of patients (73%) as the worst negative experiences. Most GPs choose to provide off-duty outsourcing services on their own: 85% of GPs outsource services up to 25% of their working time. The proportion of outsourcing services increased with age. The primary reason for outsourcing is the desire to have more private time (76%); high daytime working hours (71%); and non-working hours low working hours (46%). Conclusions General practitioners are encouraged to participate in non-working-time general practitioner cooperation projects to reduce outsourcing. The most negative experience for GPs is peak workload and a large number (non-urgent) of help needs. In order to motivate more general practitioners to provide primary health care services for 7 days and 24 hours, defining their workload is even more important.