Skip to main content
PMC home page
The British Journal of General Practice logoLink to The British Journal of General Practice
. 2002 Dec;52(485):981–987.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

S Buetow 1, V Adair 1, G Coster 1, M Hight 1, B Gribben 1, E Mitchell 1
PMCID: PMC1314467  PMID: 12528583

Abstract

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Full Text

The Full Text of this article is available as a PDF (83.0 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Churchill R., Allen J., Denman S., Williams D., Fielding K., von Fragstein M. Do the attitudes and beliefs of young teenagers towards general practice influence actual consultation behaviour? Br J Gen Pract. 2000 Dec;50(461):953–957. [PMC free article] [PubMed] [Google Scholar]
  2. Crain E. F., Kercsmar C., Weiss K. B., Mitchell H., Lynn H. Reported difficulties in access to quality care for children with asthma in the inner city. Arch Pediatr Adolesc Med. 1998 Apr;152(4):333–339. doi: 10.1001/archpedi.152.4.333. [DOI] [PubMed] [Google Scholar]
  3. Davis P., Lay-Yee R., Maingay S., Gribben B. Patterns of general practitioner usage among Pacific people: indicative results from the Waikato Medical Care Survey 1991-2. N Z Med J. 1997 Sep 12;110(1051):335–336. [PubMed] [Google Scholar]
  4. Dermer M., Faloon T., Pelletier S., Swiggum S. Taking control of your appointment schedule. Part 1: Reconciling income expectations with patient visits. Can Fam Physician. 2001 Jun;47:1272–1273. [PMC free article] [PubMed] [Google Scholar]
  5. Fallon C. W., Hamilton I., Bhopal J. S., Gilmour H. W., Bhopal R. S. Introduction of an appointment system in a general practice: surveys of patients and staff. Health Bull (Edinb) 1990 Sep;48(5):232–237. [PubMed] [Google Scholar]
  6. Frankenberg R. "Your time or mine?" An anthropological view of the tragic temporal contradictions of biomedical practice. Int J Health Serv. 1988;18(1):11–34. doi: 10.2190/GCUH-MG8G-JPKV-NLBQ. [DOI] [PubMed] [Google Scholar]
  7. Gallagher M., Pearson P., Drinkwater C., Guy J. Managing patient demand: a qualitative study of appointment making in general practice. Br J Gen Pract. 2001 Apr;51(465):280–285. [PMC free article] [PubMed] [Google Scholar]
  8. Goodyear-Smith F., Buetow S. Power issues in the doctor-patient relationship. Health Care Anal. 2001;9(4):449–462. doi: 10.1023/A:1013812802937. [DOI] [PubMed] [Google Scholar]
  9. Little P., Everitt H., Williamson I., Warner G., Moore M., Gould C., Ferrier K., Payne S. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ. 2001 Oct 20;323(7318):908–911. doi: 10.1136/bmj.323.7318.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Luthra M., Marshall M. N. How do general practices manage requests from patients for 'same-day' appointments? A questionnaire survey. Br J Gen Pract. 2001 Jan;51(462):39–41. [PMC free article] [PubMed] [Google Scholar]
  11. Murray M., Tantau C. Redefining open access to primary care. Manag Care Q. 1999 Summer;7(3):45–55. [PubMed] [Google Scholar]
  12. Reti S. Patient waiting times. N Z Med J. 1994 Mar 23;107(974):104–106. [PubMed] [Google Scholar]
  13. Taylor B. Patient use of a mixed appointment system in an urban practice. Br Med J (Clin Res Ed) 1984 Nov 10;289(6454):1277–1278. doi: 10.1136/bmj.289.6454.1277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Wilson A. Consultation length in general practice: a review. Br J Gen Pract. 1991 Mar;41(344):119–122. [PMC free article] [PubMed] [Google Scholar]

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners

RESOURCES