How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact
How are abnormal results for liver function tests dealt with in primary care? Audit of yield and impact
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DOI：
10.1136/bmj.322.7281.276
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发表时间：
2001-02-03
影响因子：
--
通讯作者：
Ryder, S
中科院分区：
文献类型：
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作者：
Sherwood, P;Lyburn, I;Ryder, S
目的确定肝功能异常结果是否在初级保健和全面调查的结果中被调查。设计回顾性调查和前瞻性临床研究。建立大学医院和周边全科诊所，服务于大约33万人。受试者是1995年1月1日至6月30日根据医生要求的肝功能检查结果异常的成年人。干预研究所有血清丙氨酸氨基转移酶、丙氨酸氨基转移酶或碱性磷酸酶水平至少为参考范围上限的两倍以上的患者。15个月后(范围12-21)的住院就诊记录和进一步调查的中位数进行了检查。在调查不完整的情况下，检查全科医生的记录，邀请合适的患者到肝脏诊所就诊。主要结果指标根据医生的要求进行调查并获得最终诊断。结果933例肝功能异常患者中，873例(94%)获得随访资料。531名患者已经在医院接受复查。在剩下的342名患者中，157名适合调查；其他人已经死亡、搬走、老年或重复进行肝功能测试，结果正常。其中91名患者(58%)没有被要求进行进一步的测试。他们的医生对66名患者进行了部分调查，其中7名患者的结果表明，一种可治疗的慢性肝病没有得到随访。在调查中，97例(62%)有可识别的诊断，需要医院介入随访或两者兼而有之。结论肝功能异常结果往往没有得到充分的调查，错过了识别可治疗的慢性肝病的重要变化。
Objective To determine whether abnormal results for liver function tests are investigated in primary care and findings on full investigation.Design Retrospective audit and prospective clinical investigation.Setting University hospital and surrounding general practices serving a round 330 000 people.Subjects Adults with abnormal results for liver function based on tests requested by their doctor between 1 January and 30 June 1995.Interventions All patients with gamma -glutamyltransferase, alanine aminotransferase, or alkaline phosphatase concentrations at least twice the upper limit of the reference range were studied. A median of 15 months later (range 12-21) records of hospital attendances and further investigations were examined. Where investigations were incomplete the records from the general practiced were examined, and suitable patients were invited to attend the liver clinic.Main outcome measures Investigations requested by the doctor and final diagnoses reached.Results 933 patients with abnormal liver function tests were identified follow up data were obtained in 873 (94%). 531 patients were already under hospital review. Of the remaining 342 patients, 157 were suitable for investigation; the others had died, moved away, were elderly, or had repeat liver function tests with normal results. No further tests were requested for 91 (58%) of these patients. 66 had been partially investigated by their doctor, and in seven patients results suggesting a treatable chronic liver disease had not been followed up. On investigation, 97 (62%) had an identifiable diagnosis requiring hospital intervention for follow up, or both.Conclusions Abnormal results for liver function are often not adequately investigated, missing an important change of identifying treatable chronic liver disease.