Horlock N, Cole R P, Rossi A R
RAFT Institute for Plastic Surgery, Mount Vernon Hospital, Northwood, UK.
Br J Plast Surg. 1999 Mar;52(2):118-21. doi: 10.1054/bjps.1997.3052.
Selective or restrictive access policies operate for breast reduction, despite proven benefits. The rationale for these policies, in particular the requirement of psychiatric assessment prior to a plastic surgical consultation, as an aid to patient selection by the health commission, was examined in 57 general practice referrals to a plastic surgical unit. In 22 cases, these policies deterred the patient or GP from pursuing the referral further. Sixteen cases were funded by the health commission directly, 16 patients required psychiatric or orthopaedic referrals, and three patients were refused funding outright. The decision to fund, reject or refer to a non-plastic-surgical specialist was not statistically related to the patients' symptoms. Non-plastic-surgical assessment resulted in referral for a plastic surgical opinion in 15 of 16 patients. We conclude that these selective policies are unsatisfactory, since patient management is not related to symptoms and the use of non-plastic-surgical opinions by the health commission as an aid to rationing is of little benefit.
尽管乳房缩小术已被证实有诸多益处，但仍实施了选择性或限制性的准入政策。在向一个整形外科单位转诊的57例全科医疗病例中，对这些政策的基本原理，尤其是在整形外科会诊前进行精神科评估这一要求（作为卫生委员会进行患者选择的辅助手段）进行了研究。在22例病例中，这些政策阻碍了患者或全科医生进一步推进转诊。16例病例由卫生委员会直接提供资金，16例患者需要精神科或骨科转诊，3例患者被直接拒绝提供资金。是否提供资金、拒绝或转诊至非整形外科专科医生的决定与患者的症状并无统计学关联。在16例患者中，有15例经非整形外科评估后被转诊以获取整形外科意见。我们得出结论，这些选择性政策并不令人满意，因为患者管理与症状无关，且卫生委员会利用非整形外科意见来进行资源分配几乎没有益处。
