Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study
Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study
复制标题
影响终末期肾衰竭患者全科医生转诊的因素：标准化病例分析研究
DOI：
--
复制
发表时间：
2006
影响因子：
2.8
通讯作者：
John Donohoe
中科院分区：
文献类型：
--
作者：
Anthony J Montgomery;Hannah M McGee;William Shannon;John Donohoe
为了了解爱尔兰ESRF的治疗转诊率低于其他欧洲国家的原因，对影响ESRF患者的全科医生转诊的因素进行了调查。方法随机选择全科医生(N=51)，使用32个标准化的书面患者情景进行访谈，以得出转诊策略。主要观察指标：终末期肾病患者的全科医生转诊水平和阈值；转诊途径(肾科医生与其他医生)；患者年龄、婚姻状况和合并症对转诊的影响。结果在考虑第一个实验室结果后，不同医生转诊的所有病例(0-32例；中位数=15例)的转诊水平差异很大。不到一半(44%)的病例转诊给肾科医生。患者年龄(40岁对70岁)、婚姻状况、合并症(无类风湿性关节炎)和全科医生既往专科肾脏培训(是或否)不影响转诊率。许多患者没有被转介到肌酐水平为129Mol/L(47%未转诊)或250μMol/L(45%)的专科医生。当所有患者被转诊至更高水平(350和480μ摩尔/L)时，转诊至肾病专科医生的可能性随着情况变得更加复杂而降低；在129μ摩尔/L肌酐时为28%；在250μ摩尔/L时为28%；在350μ摩尔/L时为18%；在480μ摩尔/L时为14%。转诊水平和转诊路线不受全科医生年龄、性别或执业地点的影响。大多数全科医生目前与慢性肾脏病患者接触很少(实际平均人数=0.7，S.D.结论所确定的非常不同的管理模式突出了指导全科医生适当处理这一严重疾病的必要性。
BackgroundTo understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted.MethodRandomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral.ResultsReferral levels varied widely with the full range of cases (0–32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 μmol/l (47% not referred) or 250 μmol/l (45%). While all patients were referred at higher levels (350 and 480 μmol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 μmol/l creatinine; 28% at 250 μmol/l; 18% at 350 μmol/l and 14% at 480 μmol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3).ConclusionThe very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.
评估生活质量——一项针对新诊断乳腺癌患者的研究。
影响因子：
7.2
作者：
Ganz,PA;Schag,CA;Cheng,HL
通讯作者：
Cheng,HL