USE OF STRUCTURED LETTERS TO IMPROVE COMMUNICATION BETWEEN HOSPITAL DOCTORS AND GENERAL-PRACTITIONERS
USE OF STRUCTURED LETTERS TO IMPROVE COMMUNICATION BETWEEN HOSPITAL DOCTORS AND GENERAL-PRACTITIONERS
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DOI：
10.1136/bmj.307.6911.1044
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发表时间：
1993-10-23
影响因子：
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通讯作者：
LLOYD, BW
中科院分区：
文献类型：
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作者：
RAWAL, J;BARNETT, P;LLOYD, BW
方法和结果 我们首先写信给在北米德尔塞克斯医院 NHS 信托基金辖区工作的 100 名随机选择的全科医生。我们给他们每人发了两封不同的信，内容是关于与儿科医生的同一个虚构咨询（盒子），并要求他们说出他们更喜欢哪封信。信件 A 是结构化信件，包含问题清单和管理建议清单。字母 B 有相同的问题清单，但管理建议按照惯例包含在文本中。其余大部分文本都是相同的。然后，我们审查了全科诊所 (PB) 连续收到的 100 封关于新转诊到医院诊所的患者的信件。我们确定了医院的名称、写信的医生的专业和级别，以及信中是否包含问题清单或管理建议清单。 100名全科医生中有92人回答道。在这 92 人中，81 人喜欢结构化信件，六人喜欢仅包含问题列表的信件，五人表示不喜欢。研究第二部分分析的 100 封信件是由 16 家不同医院 20 个不同专业的医生撰写的。五封信是结构化的（同时包含问题清单和管理建议清单），而五封仅包含问题清单，一封仅包含管理建议清单。 89 封信按照传统方式编写。 评论 我们发现，在我们的研究中，几乎所有全科医生都喜欢结构化信，但很少有医院医生会写这样的信。我们相信我们的结果具有普遍适用性。因为在我们随机选择的样本中，92% 的全科医生做出了回应，他们的观点很可能代表了整个英国全科医生。与我们之前的研究一样，我们虚构的信件来自一位儿科医生，但我们相信，我们在其他专业也会得到类似的结果。关于如何改善医院医生和全科医生之间的沟通的研究很少。我们之前没有发现关于使用结构化信函的研究。与传统信函相比，结构化信函有四个优点。首先，它们要求作者简明地陈述他或她认为患者的问题是什么以及应该如何处理这些问题。其次，读者一眼就能看出作者的观点。第三，它们更短。第四，全科医生可以更容易地将信息从结构化信函转移到计算机化的病历中。
Methods and results We first wrote to 100 randomly chosen general practitioners working in the catchment area of North Middlesex Hospital NHS Trust. We sent them each two different letters about the same fictional consultation with a paediatrician (box) and asked them to say which letter they preferred. Letter A, the structured letter, contained both a problem list and a list of management proposals. Letter B had the same problem list but the management proposals were included conventionally in the text. Most of the remaining text was identical. We then reviewed 100 consecutive letters received in a general practice (PB's) about patients who had been newly referred to a hospital clinic. We determined the name of the hospital, the specialty and grade of the doctor who had written the letter, and whether the letter contained either a problem list or a list of management proposals. Ninety two of the 100 general practitioners replied. Of these 92, 81 preferred the structured letter, six preferred the letter with only a problem list, and five expressed no preference. The 100 letters analysed in the second part of the study had been written by doctors working at 16 different hospitals in 20 different specialties. Five letters were structured (with both a problem list and a list of management proposals) while five contained only a problem list and one only a list of management proposals. Eighty nine letters were conventionally compiled.Comment We found that nearly all the general practitioners in our study preferred the structured letter but few hospital doctors wrote such letters. We believe that our results are generally applicable. Because 92% ofgeneral practitioners in our randomly chosen sample responded their views are likely to be representative of British general practitioners as a whole. As in our previous study, our fictional letters came from a paediatrician, but we believe that we would have obtained similar results with other specialties. There have been few studies of ways to improve communiction between hospital doctors and general practitioners. l" We have found no previous studies of the use of structured letters. Structured letters have four advantages over conventionalletters. Firstly, they oblige the writer to state concisely what he or she thinks the patient's problems are and how they should be managed. Secondly, the reader can see at a glance what the writer's views are. Thirdly, they are shorter. Fourthly, general practitioners can transfer information more easily from structured letters to computerised patient records.