Gómez-Moreno N, Orozco-Beltrán D, Carratalá-Munuera C, Gil-Guillén V
Centro de Salud Hospital Provincial, Area de Salud 16, Comunidad Valenciana, Alicante, Spain.
Aten Primaria. 2006 Mar 15;37(4):195-202. doi: 10.1157/13085949.
To evaluate the trends in the inter-professional relationship between primary health care (PHC) and secondary care (hospital) at 2 different moments of the health reform, at its start in 1992 and after a phase of consolidation (2001).
Observational study based on modified Delphi technique.
Valencia Community, Spain.
One hundred and ninety six professionals from Valencia Community were selected (103 PH centre administrators, 43 hospital and PC medical directors, and 50 heads of internal medicine or emergency services).
One hundred and ninety six questionnaires were sent out, with a response rate of 38%. In PHC problems remained the same, but the following got worse: "lack of motivation" (+1.34), "lack of overall vision of patients" (+1.10), and "overuse of medical services" (+1.06). The existence of non-integrated out-patient specialists got better (-1.32). In hospitals, "lack of overall vision of patients" got worse (+0.51), but in general problems got better, especially in "lack of communication and dialogue" (-1.14). PC increased its demand for "a single computerized clinical record" (+1.50), drawing up of common protocols (+0.86), and periodic rotations of PC doctors through hospitals (+0.85), but bureaucratic referrals to PC (-0.60) and the need for specialists in PC as consultants (-0.36) diminished. In hospitals all solutions showed lower scores, particularly access of PC doctors to monitoring of admitted patients (-2.44) and PC doctors doing hospital cover (-2.30).
Problems and solutions from PHC and hospitals remain the same, but there is a trend to the worse in PHC, whereas in hospitals the trend is more positive.
评估在卫生改革的两个不同阶段（1992年改革启动时和巩固阶段后（2001年）），初级卫生保健（PHC）与二级保健（医院）之间跨专业关系的趋势。
基于改良德尔菲技术的观察性研究。
西班牙巴伦西亚自治区。
选取了来自巴伦西亚自治区的196名专业人员（103名初级卫生保健中心管理人员、43名医院和初级卫生保健医疗主任以及50名内科或急诊科负责人）。
共发出196份问卷，回复率为38%。在初级卫生保健方面，问题保持不变，但以下问题有所恶化：“缺乏动力”（+1.34）、“对患者缺乏整体认知”（+1.10）以及“医疗服务过度使用”（+1.06）。非整合型门诊专科医生的情况有所改善（-1.32）。在医院，“对患者缺乏整体认知”问题恶化（+0.51），但总体问题有所改善，尤其是“缺乏沟通与对话”方面（-1.14）。初级卫生保健增加了对“单一计算机化临床记录”（+1.50）、制定共同方案（+0.86）以及初级卫生保健医生定期到医院轮转（+0.85）的需求，但转介到初级卫生保健的官僚程序（-0.60）以及将初级卫生保健专科医生作为顾问的需求（-0.36）减少。在医院，所有解决办法的得分都较低，尤其是初级卫生保健医生对住院患者的监测权限（-2.44）以及初级卫生保健医生进行医院值班（-2.30）。
初级卫生保健和医院的问题及解决办法保持不变，但初级卫生保健有恶化趋势，而医院的趋势更为积极。
