Carter Bryan D, Kronenberger William G, Baker Janet, Grimes Laurie M, Crabtree Valerie M, Smith Courtney, McGraw Kelly
University of Louisville School of Medicine, Kentucky 40202, USA.
J Pediatr Psychol. 2003 Sep;28(6):423-32. doi: 10.1093/jpepsy/jsg032.
To conduct a prospective case-controlled study of pediatric inpatients referred for consultation in a tertiary care children's medical center.
Referrals (n = 104) were matched with nonreferrals (n = 104) for age (4 to 18 years), gender, and illness type/severity and completed parent- and self-report (dependent on age) behavioral rating scales to assess for adjustment/functioning. Nurses completed in-hospital ratings of behavioral/adjustment difficulties. Goal attainment and satisfaction ratings were obtained from the referring physicians, parents/guardians, and the consultant.
Referrals exhibited more behavior/adjustment/coping difficulties than nonreferrals by parent, nurse, and self report. Frequently employed interventions included coping-strategies intervention, cognitive and behavioral therapies, and case management. Referring physician and consultant ratings of goal attainment were high, as were physician ratings of satisfaction and parent/guardian ratings of overall helpfulness.
Pediatric inpatients referred by their physicians had significantly more internalizing and externalizing disturbances than their nonreferred hospitalized peers. Many of the behavioral and adjustment problems that lead to in-hospital consultation referral were evident in global behavior difficulties prior to hospitalization. Referring pediatricians, parents/guardians, and consultants rate the outcome as benefiting the patients via assisting in the overall management of their health concerns, coping, and adjustment.
在一家三级儿童医疗中心对转诊进行咨询的儿科住院患者开展一项前瞻性病例对照研究。
将转诊患者（n = 104）与非转诊患者（n = 104）按年龄（4至18岁）、性别和疾病类型/严重程度进行匹配，并完成家长报告和自我报告（取决于年龄）行为评定量表，以评估适应/功能情况。护士完成对行为/适应困难的住院评定。从转诊医生、家长/监护人及会诊医生处获取目标达成情况及满意度评定。
根据家长、护士及自我报告，转诊患者比非转诊患者表现出更多的行为/适应/应对困难。常用干预措施包括应对策略干预、认知和行为疗法以及病例管理。转诊医生和会诊医生对目标达成情况的评定较高，医生对满意度的评定以及家长/监护人对总体帮助程度的评定也较高。
经医生转诊的儿科住院患者比未转诊的住院同龄人有明显更多的内化和外化障碍。许多导致住院会诊转诊的行为和适应问题在住院前的整体行为困难中就已很明显。转诊儿科医生、家长/监护人及会诊医生认为该结果通过协助患者全面管理其健康问题、应对和适应，使患者受益。
