• 作者：F.J. Luque-Mellado ; ^{fjluque@gencat.cat} ; M. Gili-Ribes ; R. Berenguer-Gasc&#243 ; n ; F.J. Martos-Molines ; S. Oriach-Alonso ; X. Quesada-Couceiro ; L. Gallego-Á ; lvarez
• 关键词：Atenció ; n Primaria de Salud ; Cita previa ; Calidad asistencial ; Hiperfrecuentació ; n
• 刊名：SEMERGEN - Medicina de Familia
• 出版年：2010
• 期刊代码：pca342_11383593
• 类别：med
• 出版时间：May 2010
• 卷：36
• 期：5
• 页码：243-252
• 文件大小：296 K

lass="h4">Introduction

Demand management and particularly demand with no previous appointment is a challenge that concerns managers and professionals. Although the reasons have been extensively studied, the solution is not simple.

Since perception of excessive demand was the main reason of dissatisfaction of our professional team, we planned and implemented an organizational change with interventions on professional organization and structure to improve overall management of demand and particularly that generated with no previous appointment, to reduce excessive use and also increase the quality of the care to all the patients of the Primary Care Team (PCT).

lass="h4">Material and methods

Detection of the processes to improve. Some of the most important interventions are summarized: multidisciplinary planning; creation of two separate care systems for the scheduled visit and the visit without an appointment; elimination of the bureaucratic aspects of the consultations; development of standards and standardization of performance criteria on visits with and without appointment; enhancing the role of nurses and administrative attention to the population in both the scheduled visit and in the spontaneous visit; changes of location to enhance the doctor-nurse collaboration.

A statistical analysis and evaluation of results were performed.

lass="h4">Results

A significant reduction was achieved in the total number of visits to the center of those with or without an appointment and in those patients with a high number of visits (both p<0.001). The roles of nurse and administrative were strengthened. The satisfaction surveys of the users and professionals regarding the new system have been positive.

lass="h4">Conclusion

A multidisciplinary strategy, developed and agreed on by the whole team, has a positive influence on demand and improves quality of care.