title: Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?
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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach.
  
  
  METHODS
  Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Practice and Primary Health Care, University of Auckland, Private Bag 92019, Auckland, New Zealand. s.buetow@auckland.ac.nz
authors.forename: S
authors.initials: S
authors.lastname: Buetow
authors.forename: V
authors.initials: V
authors.lastname: Adair
authors.forename: G
authors.initials: G
authors.lastname: Coster
authors.forename: M
authors.initials: M
authors.lastname: Hight
authors.forename: B
authors.initials: B
authors.lastname: Gribben
authors.forename: E
authors.initials: E
authors.lastname: Mitchell
mesh_terms: D000328:Adult; D000368:Aged; D001249:Asthma / Q000628:therapy; D005194:Family Practice / Q000458:organization & administration*; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018802:Patient-Centered Care / Q000458:organization & administration; D017748:Time Management / Q000458:organization & administration*; D014850:Waiting Lists