Baker R C, Schubert C J, Kirwan K A, Lenkauskas S M, Spaeth J T
Department of Pediatrics, University of Cincinnati, College of Medicine, Children's Hospital Medical Center, Ohio 45229-3039, USA.
Arch Pediatr Adolesc Med. 1999 Mar;153(3):292-6. doi: 10.1001/archpedi.153.3.292.
To compare the content of after-hours medical triage and advice calls regarding private practice patients vs nonprivate practice patients and to assess caregiver compliance with advice resulting from these calls.
Survey of after-hours medical triage and advice calls during a 2-week period (September 1 through 15, 1996).
Three private practices (serving approximately 24 000 patients) and 1 urban hospital-based, non-private practice (serving approximately 12 000 patients).
After-hours medical triage and advice calls from caregivers of patients receiving their primary care in these settings.
Compliance with recommended emergency department (ED) or office visit referrals.
A total of 286 calls regarding private practice patients and 377 calls regarding nonprivate practice patients were received (P<.001). Eighty-one calls were referred by the nurse directly to the physician. Fifty-nine private practice patients and 59 nonprivate practice patients were referred to the ED. Caregivers of 94 private practice patients and 132 nonprivate practice patients were given home treatment advice. Appointments to be seen at their primary care source were given for 78 private practice patients and 160 nonprivate practice patients. Non-private practice patients were more likely to be referred for office care (P=.005); private practice patients were more likely to be referred to the ED (P=.01). Compliance with ED referrals was 42% for patients of nonprivate practice and 46% for private practice; for office visit referrals, compliance was 64% for nonprivate practice and 69% private practice patients (P=.71 for compliance with ED referrals and P=.40 for compliance with office referrals).
Compliance with recommended physician encounters was not significantly different (and lower than expected) in both groups of patients. Private practice patients are more likely to be referred to the ED. Calls for nonprivate practice patients are more frequent and these patients are more likely to be referred to their primary care source. This difference may be due to caregivers of patients from nonprivate practices seeking advice for less serious conditions. Physicians should address telephone medicine with caregivers proactively during health maintenance visits.
比较针对私人执业患者与非私人执业患者的非工作时间医疗分诊及咨询电话的内容，并评估护理人员对这些电话所提供建议的依从性。
对1996年9月1日至15日这两周内的非工作时间医疗分诊及咨询电话进行调查。
三家私人诊所（服务约24000名患者）和一家城市医院的非私人执业机构（服务约12000名患者）。
在这些机构接受初级护理的患者的护理人员拨打的非工作时间医疗分诊及咨询电话。
对推荐的急诊科（ED）就诊或门诊就诊转诊的依从性。
共收到286个关于私人执业患者的电话和377个关于非私人执业患者的电话（P<0.001）。81个电话由护士直接转接给医生。59名私人执业患者和59名非私人执业患者被转诊至急诊科。94名私人执业患者和132名非私人执业患者的护理人员得到了家庭治疗建议。78名私人执业患者和160名非私人执业患者被安排在其初级护理机构就诊。非私人执业患者更有可能被转诊至门诊护理（P=0.005）；私人执业患者更有可能被转诊至急诊科（P=0.01）。非私人执业患者对急诊科转诊的依从性为42%，私人执业患者为46%；对于门诊就诊转诊，非私人执业患者的依从性为64%，私人执业患者为69%（急诊科转诊依从性P=0.71，门诊转诊依从性P=0.40）。
两组患者对推荐的医生会诊的依从性没有显著差异（且低于预期）。私人执业患者更有可能被转诊至急诊科。非私人执业患者的电话更频繁，且这些患者更有可能被转诊至其初级护理机构。这种差异可能是由于非私人执业患者的护理人员针对病情较轻的情况寻求建议。医生应在健康维护就诊期间主动与护理人员讨论电话医疗问题。
