GPs' reasons for referral of patients with chest pain: a qualitative study
GPs' reasons for referral of patients with chest pain: a qualitative study
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DOI：
10.1186/1471-2296-10-55
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发表时间：
2009-07-31
影响因子：
2.9
通讯作者：
Aertgeerts, Bert
中科院分区：
文献类型：
--
作者：
Bruyninckx, Rudi;Van den Bruel, Ann;Aertgeerts, Bert
背景资料：急性冠状动脉综合征的及时诊断非常重要，必须紧急转诊到医院，因为快速治疗可以挽救生命，并增加患者的预期寿命和生活质量。我们的研究的目的是确定全科医生的原因，指或不指患者提出胸痛。方法：在一个半结构化的采访，21全科医生被要求描述为什么他们做或不指患者提出胸痛。结果：21例患者的病史进行了研究。6人没有被转诊，7人被转诊给心脏病专家，8人被转诊给急诊科。全科医生转诊的原因是对患者的背景知识，患者的年龄和成本效益估计，医疗救援队的负面态度的看法，最近的患者与心脏病专家接触没有检测到冠状动脉疾病和体征和症状的实际表现，直觉，临床检查和心电图结果。这项研究表明，全科医生认为，他们并不完全使用的“经典”的迹象和症状，在他们的决策过程中，病人提出胸痛。关于病人的背景知识，全科医生的个人想法和直觉也很重要。
Background: Prompt diagnosis of an acute coronary syndrome is very important and urgent referral to a hospital is imperative because fast treatment can be life-saving and increase the patient's life expectancy and quality of life. The aim of our study was to identify GPs' reasons for referring or not referring patients presenting with chest pain.Methods: In a semi-structured interview, 21 GPs were asked to describe why they do or do not refer a patient presenting with chest pain. Interviews were taped, transcribed and qualitatively analysed.Results: Histories of 21 patients were studied. Six were not referred, seven were referred to a cardiologist and eight to the emergency department. GPs' reasons for referral were background knowledge about the patient, patient's age and cost-benefit estimation, the perception of a negative attitude from the medical rescue team, recent patient contact with a cardiologist without detection of a coronary disease and the actual presentation of signs and symptoms, gut feeling, clinical examination and ECG results.Conclusion: This study suggests that GPs believe they do not exclusively use the 'classical' signs and symptoms in their decision-making process for patients presenting with chest pain. Background knowledge about the patient, GPs' personal ideas and gut feeling are also important.