[会诊的临床管理：临床内容与可预测性（SyN-PC研究）]
[Clinical management of consultations: clinical content and predictability (SyN-PC Study)].
作者信息
Orozco Beltrán D, Pedrera Carbonell V, Gil Guillén V, Prieto Erades I, Ribera Montés M C, Martínez Cánovas P
机构信息
Unidad de Investigación y Docencia, Area 17, Comunidad Valenciana, España.
出版信息
Aten Primaria. 2004 Feb 15;33(2):69-77. doi: 10.1016/s0212-6567(04)79354-3.
OBJECTIVES
To describe care activity as a function of the nature of the consultation (predictability) and the needs of the patients (clinical content). To analyse the relationship of these with the characteristics of the consultation, of the patient and of the centre.
DESIGN
Multi-centre, descriptive, observational study.
SETTING
Primary care. Area 17 of the Health Department of the Community of Valencia, with 197316 inhabitants and 12 health centres.
PARTICIPANTS
Information gathering in real time by outside observer. Stratified randomised sampling of 2051 patients who gave rise to 3008 reasons for medical consultation.
MAIN MEASUREMENTS
Predictable consultations (Pr): their content can be foreseen (check-ups, picking up results). Unpredictable consultations (Unp): we cannot predict their content (acute problems may arise unexpectedly). These include urgent consultations. Administrative consultations (Ad): bureaucratic tasks (prescriptions, repeat sick-notes, sick certificates). Care consultations (Car): prevention, diagnosis and treatment of the illness, or monitoring of it. Variables here are the patient, the doctor and the consultation.
RESULTS
60% (1809) (95% CI, 58.69%-61.59%) of the reasons were Pr and 40% (1199) (95% CI, 36.6%-43.12%) were Unp. 50% (1509) (95% CI, 47.26%-53.06%) were Car, and 50% Ad (1499) (95% CI, 46.34%-53.39%). 40% (1189) (95% CI, 37.78%-41.28%) were Pr-Ad and only 21% (620) (95% CI, 19.16%-22.06%) were Pr-Car. 30% (889) (95% CI 27.92 %-31.18%) were Unp-Car, and 10% (310) (95% CI, 9.22%-11.4%) Unp-Ad. 48% of patients with a single reason for attendance were Pr-Ad (577) (95% CI, 44.25%-52.05). Teaching centres and computerised ones had less Pr-Ad load. Pr-Ad consultations increased with patient's age and with case-load.
CONCLUSIONS
Almost 40% of the reasons for consultation are Pr-Ad, which implies inadequate clinical management. An intervention is needed to free up medical time consumed by bureaucratic questions, so that this time can be devoted fully to health-care tasks.
目的
将护理活动描述为会诊性质（可预测性）和患者需求（临床内容）的函数。分析这些因素与会诊特征、患者特征及医疗中心特征之间的关系。
设计
多中心、描述性观察研究。
设置
初级保健。巴伦西亚自治区卫生部第17区，有197316名居民和12个医疗中心。
参与者
由外部观察者实时收集信息。对2051名患者进行分层随机抽样，这些患者产生了3008次会诊原因。
主要测量指标
可预测会诊（Pr）：其内容可预见（体检、取检查结果）。不可预测会诊（Unp）：我们无法预测其内容（可能意外出现急性问题）。这些包括紧急会诊。行政会诊（Ad）：官僚任务（开处方、开具病假条、病假证明）。护理会诊（Car）：疾病的预防、诊断和治疗或对其进行监测。这里的变量是患者、医生与会诊。
结果
60%（1809）（95%置信区间，58.69%-61.59%）的会诊原因是可预测的，40%（1199）（95%置信区间，36.6%-43.12%）是不可预测的。50%（1509）（95%置信区间，47.26%-53.06%）是护理会诊，50%是行政会诊（1499）（95%置信区间，46.34%-53.39%）。40%（1189）（95%置信区间，37.78%-41.28%）是可预测行政会诊，只有21%（620）（95%置信区间，19.16%-22.06%）是可预测护理会诊。30%（889）（95%置信区间27.92%-31.18%）是不可预测护理会诊，10%（310）（95%置信区间，9.22%-11.4%）是不可预测行政会诊。48%只有一个就诊原因的患者是可预测行政会诊（577）（95%置信区间，44.25%-52.05）。教学中心和计算机化中心的可预测行政会诊负担较轻。可预测行政会诊随患者年龄和工作量增加而增加。
结论
近40%的会诊原因是可预测行政会诊，这意味着临床管理不足。需要进行干预，以腾出被官僚问题消耗的医疗时间，使这段时间能够完全用于医疗保健任务。
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