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基层医疗中频繁就诊是否具有疾病特异性?

Is frequent attendance in primary care disease-specific?

作者信息

Foster Alison, Jordan Kelvin, Croft Peter

机构信息

Primary Care Sciences Research Centre, Keele University, Keele, Staffs ST5 5BG, UK.

出版信息

Fam Pract. 2006 Aug;23(4):444-52. doi: 10.1093/fampra/cml019. Epub 2006 May 4.

DOI:10.1093/fampra/cml019
PMID:16675502
Abstract

BACKGROUND

Sociodemographic characteristics of frequent attenders in general practice are known. It is not known whether frequent attendance is linked to specific diseases.

OBJECTIVE

To investigate whether frequent consultation in primary care is related to specific morbidities and whether this relationship is influenced by the general practice which the patient attends.

DESIGN

One-year survey of consultation data.

SETTING

Nine general practices in North Staffordshire, UK.

PARTICIPANTS

1000 adults aged 18 years and over who had consulted primary care at least once during the study year were randomly selected from each practice and grouped into frequent (high and very high), medium and low frequency consulters.

MAIN OUTCOME MEASURES

Type of morbidity coded at each consultation and number of repeat consultations for each morbidity (based on Read Code Chapters).

RESULTS

All morbidity Chapters were associated with frequent consultation. Frequent consultation was also associated with repeated consultation within most morbidities. Stronger associations were seen with mental disorders, blood disorders, circulatory disorders, digestive disorders, endocrine diseases and with causes of injury and poisoning. Some variation between practices in the morbidities associated with frequent consultation were apparent; particularly for skin diseases and unspecified conditions.

CONCLUSIONS

Frequent consulters in primary care are not restricted to particular groups of morbidities. There is some aspect of frequent consultation that is a characteristic of individuals regardless of the symptoms with which they consult. Some morbidities are more prominent than others in this group of consulters, and this may help guide practice policies and future research into frequent consulters.

摘要

背景

一般诊疗中频繁就诊者的社会人口学特征已为人所知。但尚不清楚频繁就诊是否与特定疾病相关。

目的

调查基层医疗中的频繁就诊是否与特定疾病相关,以及这种关系是否受患者就诊的全科诊所影响。

设计

对就诊数据进行为期一年的调查。

地点

英国北斯塔福德郡的9家全科诊所。

参与者

从每家诊所中随机选取1000名年龄在18岁及以上、在研究年度内至少就诊过一次基层医疗的成年人,并将其分为频繁就诊者(高频率和非常高频率)、中等频率就诊者和低频率就诊者。

主要观察指标

每次就诊时编码的疾病类型以及每种疾病的复诊次数(基于Read编码章节)。

结果

所有疾病章节都与频繁就诊相关。频繁就诊还与大多数疾病的复诊相关。在精神障碍、血液疾病、循环系统疾病、消化系统疾病、内分泌疾病以及损伤和中毒原因方面,关联更为明显。不同诊所在与频繁就诊相关的疾病方面存在一些差异;特别是皮肤病和未明确的病症。

结论

基层医疗中的频繁就诊者并不局限于特定的疾病群体。频繁就诊的某些方面是个体的特征,与他们就诊时的症状无关。在这组频繁就诊者中,某些疾病比其他疾病更为突出,这可能有助于指导诊疗政策以及未来对频繁就诊者的研究。

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