DISBANDING A MULTIDISCIPLINARY CLINIC - EFFECTS ON THE HEALTH-CARE OF MYELOMENINGOCELE PATIENTS
DISBANDING A MULTIDISCIPLINARY CLINIC - EFFECTS ON THE HEALTH-CARE OF MYELOMENINGOCELE PATIENTS
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DOI：
10.1159/000120812
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发表时间：
1994-01-01
影响因子：
0.7
通讯作者：
PARK, TS
中科院分区：
文献类型：
--
作者：
KAUFMAN, BA;TERBROCK, A;PARK, TS
1963年在我院建立了一个多学科诊所，用于评估和护理中枢神经系统畸形儿童，并于1988年解散。三年后，对脊髓脊膜膨出患者（n = 87）进行回顾性电话调查，以确定诊所关闭对这些患者的健康和护理的影响。在诊所解散后，45-66%的脊髓脊膜膨出患者未能获得定期的医疗和专科护理，尽管在同一地点继续提供相同的专科护理。最显著的相关性是老年患者的护理频率较低;这种医疗保健利用的失败与患者的保险状况无关。这种缺乏关怀的情况并不是良性的。在随访时间最短的患者中发现严重发病率增加，包括截肢和肾切除，但对照组中没有。在协调病人的护理方面存在着一个重大问题;病人、家属和当地医生都不承担护理协调员的职责。这篇综述表明，如果一个多学科诊所被解散，很大一部分患者将无法保持足够的医疗随访，并且在几年内可能会发生严重的发病率。期望仅仅维持已解散诊所的个别服务，而没有一些护理协调员，继续提供有效的护理是不现实的。
A multidisciplinary clinic for the evaluation and care of children with central nervous system malformations was established at our hospital in 1963 and disbanded in 1988. Three years later, a retrospective telephone survey of myelomeningocele patients (n = 87) was used to identify the effect of clinic closing on the health and care of these patients. After the clinic was disbanded, 45-66% of myelomeningocele patients failed to have regular medical and specialty care, despite the continued availability of the same specialty care in the same location. The most significant correlation was that older patients had less frequent care; this failure in health care utilization was not related to the patients' insurance status. This lack of care is not benign. An increase in serious morbidity, including amputation and nephrectomy, was detected in those patients with the least follow-up, but not in the control group. A significant problem with coordination of the patients' care exists; neither the patient, the family, nor the local physician assumes the duties of coordinator of care. This review indicates that if a multidisciplinary clinic is disbanded, a large proportion of patients will fail to maintain adequate medical follow-up, and that significant morbidity can occur within several years. It is unrealistic to expect the continuation of effective care by merely maintaining the individual services of the disbanded clinic, without some coordinator of care.