Black N, Pettigrew M, McPherson K
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine.
Qual Health Care. 1993 Mar;2(1):11-6. doi: 10.1136/qshc.2.1.11.
To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately.
Cohort study of patients recruited by 25 surgeons during 1988.
Hospitals in Oxford and North West Thames regions.
Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients.
Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively.
NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001).
Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.
比较在英国国家医疗服务体系（NHS）和私立医疗体系中，因良性前列腺增生接受择期经尿道前列腺切除术的男性患者的手术阈值和临床管理情况。
1988年期间，对25位外科医生招募的患者进行队列研究。
牛津和泰晤士河北部地区的医院。
在400例连续患者中，129例被排除，原因包括接受开放手术（9例）、缺乏外科医生信息（3例）、急诊入院（117例），另有3例未提供信息，最终留下268例患者，其中214例为NHS患者，54例为私立患者。
社会人口统计学因素、症状的患病率和严重程度、合并症、术前通过患者问卷获得的总体健康状况（诺丁汉健康量表）、手术原因，以及围手术期从外科医生处获得的手术管理情况。
NHS患者和私立患者在症状严重程度和尿路异常患病率方面相似。二者在四个方面存在差异：由于合并症更多，NHS患者的总体健康状况较差（严重类别中分别为49例，23%；7例，13%）；该疾病对他们生活的不利影响更大（严重受影响的分别为36例，17%；2例，4%；p<0.01）；私立患者更快地得到了更个性化的护理，且术前接受的检查更多（接受尿路超声检查的分别为29例，54%；60例，20%）；NHS患者住院时间更长（住院超过7天的分别为57例，27%；3例，6%；p<0.001）。
从症状严重程度判断，私立患者的手术需求与NHS患者一样大，且没有证据表明两个医疗体系的手术阈值不同，但从对生活方式的影响来看，NHS患者的需求更大。
