Effects of a single-entry intake system on access to outpatient visits to specialist physicians and allied health professionals: a systematic review.

Autor: Milakovic M; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia milica.milakovic@mail.utoronto.ca., Corrado AM; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia., Tadrous M; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia., Nguyen ME; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia., Vuong S; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia., Ivers NM; Faculty of Medicine (Milakovic), Leslie Dan Faculty of Pharmacy (Tadrous), Department of Family and Community Medicine (Ivers) and Institute of Health Policy, Management and Evaluation (Ivers), University of Toronto; The Peter Gilgan Centre for Women's Cancers (Corrado) and Women's College Research Institute (Tadrous, Ivers), Women's College Hospital, Toronto, Ont.; Faculty of Medicine (Nguyen), Western University, London, Ont.; Faculty of Medicine (Vuong), University of Queensland, Brisbane, Australia.
Jazyk: angličtina
Zdroj: CMAJ open [CMAJ Open] 2021 Apr 16; Vol. 9 (2), pp. E413-E423. Date of Electronic Publication: 2021 Apr 16 (Print Publication: 2021).
DOI: 10.9778/cmajo.20200067
Abstrakt: Background: Canada lags behind other countries with respect to wait times for specialist physician and allied health professional consultations. We conducted a systematic review to assess the effects of a single-entry model on waiting time, referral volume and the satisfaction of patients and health care providers.
Methods: We searched MEDLINE, Embase, Cochrane CENTRAL and CINAHL databases from inception to December 2019. We included studies from countries in the Organisation for Economic Co-operation and Development that reported on the effects of a single-entry model on the time between referral to first assessment by a specialist physician or allied health professional, termed wait time 1 (WT1). Patient volume and the satisfaction of providers and patients were secondary outcomes. We conducted a narrative synthesis using descriptive statistics.
Results: Of the 4637 citations identified, 17 met the eligibility criteria, and we included 10 of these in the final analysis. All of the included studies reported an absolute reduction in WT1 after implementation of the single-entry model. The average percent reduction in WT1 across specialties was greatest for surgical referrals (57%) and urgent internal medicine referrals (40%). Higher initial WT1 was associated with a greater absolute reduction in WT1 after implementation of the single-entry model ( p = 0.002). Patient and provider satisfaction with the single-entry model was high in all studies. The effect estimates from all included studies were at high risk of bias.
Interpretation: Single-entry models were associated with an absolute reduction in time from referral from primary care to consultation. These models represent a promising option to improve access to a range of health services, but there is a need for rigorous prospective evaluations to inform policy.
Prospero Registration: CRD42018100395.
Competing Interests: Competing interests: None declared.
(© 2021 Joule Inc. or its licensors.)
Databáze: MEDLINE
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