临床问题的结构会影响与专科同事进行床边会诊的结果吗？

Does the structure of clinical questions affect the outcome of curbside consultations with specialty colleagues?

作者信息

Bergus G R, Randall C S, Sinift S D, Rosenthal D M

机构信息

Department of Family Medicine, University of Iowa College of Medicine, Iowa City, USA.

出版信息

Arch Fam Med. 2000 Jun;9(6):541-7. doi: 10.1001/archfami.9.6.541.

DOI:10.1001/archfami.9.6.541

PMID:10862217

Abstract

BACKGROUND

Clinical questions frequently arise during the practice of medicine, and primary care physicians frequently use curbside consultations with specialty physicians to answer these questions. It is hypothesized that well-formulated clinical questions are more likely to be answered and less likely to receive a recommendation for formal consultation.

OBJECTIVE

To assess the relationship between the structure of clinical questions asked by family physicians and the response of specialty physicians engaged in curbside consultations.

DESIGN AND PARTICIPANTS

A case series of clinical questions asked during informal consultations between 60 primary care and 33 specialty physicians using an e-mail service. Curbside consultation questions were sent, using e-mail, to academic specialty physicians by primary care physicians (faculty, residents, and community practitioners) in eastern Iowa.

MAIN OUTCOME MEASURES

Questions were analyzed to determine the clinical task and to identify 3 components: an intervention, a comparison, and an outcome. Consultants' responses were analyzed to identify whether questions were answered and whether consultants recommended formal consultation.

RESULTS

There were 708 questions in this analysis: 278 (39.3%) were diagnosis questions, 334 (47.2%) were management questions, 57 (8.0%) were prognosis questions, and 39 (5.5%) were requests for direction. Clinical questions were less likely to go unanswered or receive a recommendation for formal consultation when the question identified the proposed intervention (odds ratio, 0.54; 95% confidence interval, 0.34-0.86; P = .006) and desired outcome (odds ratio, 0.46; 95% confidence interval, 0.29-0.69; P < .001). Only 271 (38.3%) of 708 curbside consult questions identified both of these components.

CONCLUSION

Medical specialists' responses to curbside consultation questions seem to be affected by the structure of these clinical questions.

摘要

背景

临床问题在医疗实践中经常出现，基层医疗医生经常通过与专科医生进行非正规会诊来回答这些问题。据推测，精心构建的临床问题更有可能得到解答，且不太可能收到进行正式会诊的建议。

目的

评估家庭医生提出的临床问题的结构与参与非正规会诊的专科医生的回应之间的关系。

设计与参与者

这是一系列通过电子邮件服务，在60名基层医疗医生和33名专科医生之间进行的非正规会诊中提出的临床问题。爱荷华州东部的基层医疗医生（教员、住院医生和社区从业者）通过电子邮件将非正规会诊问题发送给学术专科医生。

主要观察指标

对问题进行分析以确定临床任务，并识别三个组成部分：一项干预措施、一个对照和一个结果。对会诊医生的回复进行分析，以确定问题是否得到解答以及会诊医生是否建议进行正式会诊。

结果

本次分析中有708个问题：278个（39.3%）是诊断问题，334个（47.2%）是管理问题，57个（8.0%）是预后问题，39个（5.5%）是寻求指导的问题。当问题明确了拟采取的干预措施（优势比，0.54；95%置信区间，0.34 - 0.86；P = 0.006）和期望的结果（优势比，0.46；95%置信区间，0.29 - 0.69；P < 0.001）时，临床问题未得到解答或收到正式会诊建议的可能性较小。在708个非正规会诊问题中，只有271个（38.3%）明确了这两个组成部分。