[全科医生与风湿病专家联合会诊对基层医疗患者的价值]

[The value of joint general practitioner and rheumatologist consultations in primary care patients].

作者信息

Schulpen G J C, Vierhout W P M, van der Heijde D M, Landewé R B, van der Linden S, Winkens R A G

机构信息

Academisch Ziekenhuis, afd. Transmurale Zorg, Postbus 5800, 6202 AZ Maastricht.

出版信息

Ned Tijdschr Geneeskd. 2003 Mar 8;147(10):447-50.

PMID:12666516

Abstract

OBJECTIVE

To compare the effects of regular referral by general practitioners to the Rheumatology outpatients' clinic with that of joint consultations by general practitioners (GPs) and rheumatologists, and to compare the subsequent treatment policy followed.

DESIGN

Randomised.

METHOD

In 1999 and 2000 all rheumatological patients who, according to the 17 participating GPs in the Maastricht region had an indication for referral, were referred to the outpatients' clinic or seen during a joint consultation where three GPs and one rheumatologist decided on a treatment policy in the presence of the patient. Agreement about diagnosis and diagnostic and therapeutic approaches between the rheumatologists and GPs was determined using questionnaires. The patient's state of health was assessed using the 'EuroQol health-related quality of life questionnaire' (EuroQol) and their satisfaction was determined by means of questionnaires.

RESULTS

One hundred and sixty-six patients were included: 45 (27%) men and 121 (73%) women, with an average age of 53.7 years (SD: 14). The rheumatologists and the GPs differed in opinion on the diagnosis in 64% of the patients. Agreement on diagnosis resulted in greater agreement on the treatment policy than when there were discrepancies about the diagnosis. The rheumatologist used additional diagnostic tools and follow-up consultations at the outpatient clinic (78% and 65%) more frequently than during the joint consultation (44% and 15%). Patient satisfaction and general state of health were comparable in both groups.

摘要

目的

比较全科医生定期将患者转诊至风湿病门诊与全科医生（GP）和风湿病专家联合会诊的效果，并比较随后采取的治疗策略。

设计

随机对照试验。

方法

在1999年和2000年，根据马斯特里赫特地区17名参与研究的全科医生的判断，所有有转诊指征的风湿病患者被转诊至门诊或接受联合会诊，会诊时三名全科医生和一名风湿病专家在患者在场的情况下确定治疗策略。通过问卷确定风湿病专家和全科医生在诊断、诊断方法和治疗方法上的一致性。使用“欧洲生活质量调查问卷”（EuroQol）评估患者的健康状况，并通过问卷确定他们的满意度。

结果

共纳入166例患者，其中男性45例（27%），女性121例（73%），平均年龄53.7岁（标准差：14）。在64%的患者中，风湿病专家和全科医生在诊断上存在意见分歧。诊断一致时，在治疗策略上的一致性高于诊断存在差异时。与联合会诊（44%和15%）相比，风湿病专家在门诊使用额外诊断工具和进行随访会诊（分别为78%和65%）的频率更高。两组患者的满意度和总体健康状况相当。