Li J T, Sheeler R D, Offord K P, Patel A M, Dupras D M
Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
Ann Allergy Asthma Immunol. 1999 Sep;83(3):203-6. doi: 10.1016/S1081-1206(10)62640-3.
There are few studies that examine referral patterns for asthma and few studies that examine the referring physicians' reasons for consultation.
The purpose of this study was to survey generalist physicians on their referral patterns for adult patients with asthma.
We mailed a questionnaire to all the staff (faculty) in the Department of Family Medicine and the Division of Community Internal Medicine at the Mayo Clinic in Rochester, Minnesota. There were 37 completed questionnaires (18 family medicine and 19 internal medicine) out of a total of 58 for a response rate of 64%. The survey asked what were reasons for consultation, whether allergists or pulmonologists were preferred, and the characteristics of a good consultation.
We asked respondents to indicate "how often you consult a specialist for an adult asthma patient" for a variety of clinical indications. The percentage responding "always" (for the top five indications) were if the patient requests one (46%), for allergen immunotherapy (38%), for single life-threatening attack (27%), for allergy testing (14%), and for steroid-dependent asthma or poorly controlled asthma (11%). Twenty-seven percent of respondents generally consulted allergists only, 22% generally consulted pulmonologists only, 3% indicated both, while 46% had no preference. Respondents did express a preference for a pulmonologist when the reported reason for the consultation was diagnosis of asthma uncertain, chronic cough, asthma in smoker, exercise training, or for an allergist when the reported reason for consultation was allergy evaluation or immunotherapy. The respondents indicated that the top six characteristics of a good consultation were the following: clear recommendations, clinically appropriate recommendations, high patient satisfaction, including recommendations for future management scenarios, including educational content in the consultation, and calling the referring physician before requesting a secondary consultation.
These results suggest that while consultation occurs often for severe or uncontrolled asthma, some asthma patients who may benefit from consultation may not be seeing the specialist. There were no systematic preferences for consultations with allergists versus pulmonologists for asthma although for some clinical indications pulmonologists or allergists were favored. Referring physicians value clear, clinically appropriate recommendations.
很少有研究调查哮喘的转诊模式，也很少有研究探究转诊医生的会诊原因。
本研究旨在调查全科医生对成年哮喘患者的转诊模式。
我们向明尼苏达州罗切斯特市梅奥诊所家庭医学部和社区内科分部的所有工作人员（教员）邮寄了一份问卷。在总共58份问卷中，有37份填写完整（18份家庭医学问卷和19份内科问卷），回复率为64%。该调查询问了会诊原因、是否更倾向于咨询过敏症专科医生或肺科医生以及良好会诊的特征。
我们要求受访者针对各种临床指征指出“您为成年哮喘患者咨询专科医生的频率”。回答“总是”（针对前五项指征）的百分比分别为：患者要求时（46%）、进行过敏原免疫治疗时（38%）、单次危及生命的发作时（27%）、进行过敏测试时（14%）以及激素依赖型哮喘或控制不佳的哮喘时（11%）。27%的受访者通常只咨询过敏症专科医生，22%的受访者通常只咨询肺科医生，3%的受访者表示两者都咨询，而46%的受访者没有偏好。当报告的会诊原因是哮喘诊断不确定、慢性咳嗽、吸烟者哮喘、运动训练时，受访者确实更倾向于咨询肺科医生；当报告的会诊原因是过敏评估或免疫治疗时，受访者更倾向于咨询过敏症专科医生。受访者指出良好会诊的前六项特征如下：明确的建议、临床适当的建议、高患者满意度、包括对未来管理方案的建议、会诊中包括教育内容以及在请求二次会诊前致电转诊医生。
这些结果表明，虽然严重或控制不佳的哮喘患者经常进行会诊，但一些可能从会诊中受益的哮喘患者可能没有看专科医生。虽然对于某些临床指征，肺科医生或过敏症专科医生更受青睐，但在哮喘会诊方面，对于咨询过敏症专科医生还是肺科医生并没有系统的偏好。转诊医生重视明确、临床适当的建议。
