Julian Sophia, Naftalin Nicholas J, Clark Michael, Szczepura Ala, Rashid Aly, Baker Richard, Taub Nicholas, Habiba Marwan
Reproductive Sciences Section, Department of Cancer Studies and Molecular Medicine, University of Leicester, Leicester, UK.
Qual Saf Health Care. 2007 Apr;16(2):110-5. doi: 10.1136/qshc.2005.016782.
"Referral" characterises a significant area of interaction between primary and secondary care. Despite advantages, it can be inflexible, and may lead to duplication.
To examine the outcomes of an integrated model that lends weight to general practitioner (GP)-led evidence based care.
A prospective, non-random comparison of two services: women attending the new (Bridges) pathway compared with those attending a consultant-led one-stop menstrual clinic (OSMC). Patients' views were examined using patient career diaries, health and clinical outcomes, and resource utilisation. Follow-up was for 8 months.
A large teaching hospital and general practices within one primary care trust (PCT).
Between March 2002 and June 2004, 99 women in the Bridges pathway were compared with 94 women referred to the OSMC by GPs from non-participating PCTs. The patient career diary demonstrated a significant improvement in the Bridges group for patient information, fitting in at the point of arrangements made for the patient to attend hospital (ease of access) (p<0.001), choice of doctor (p = 0.020), waiting time for an appointment (p<0.001), and less "limbo" (patient experience of non-coordination between primary and secondary care) (p<0.001). At 8 months there were no significant differences between the two groups in surgical and medical treatment rates or in the use of GP clinic appointments. Significantly fewer (traditional) hospital outpatient appointments were made in the Bridges group than in the OSMC group (p<0.001).
A general practice-led model of integrated care can significantly reduce outpatient attendance while improving patient experience, and maintaining the quality of care.
“转诊”是初级保健和二级保健之间重要的互动领域。尽管有其优势，但它可能缺乏灵活性，并且可能导致重复。
研究一种重视由全科医生（GP）主导的循证护理的综合模式的效果。
对两种服务进行前瞻性、非随机比较：采用新（Bridges）路径的女性与采用由顾问主导的一站式月经诊所（OSMC）的女性。使用患者病程日记、健康和临床结果以及资源利用情况来研究患者的观点。随访8个月。
一个初级保健信托基金（PCT）内的一家大型教学医院和全科诊所。
在2002年3月至2004年6月期间，将采用Bridges路径的99名女性与来自非参与性PCT的全科医生转诊至OSMC的94名女性进行了比较。患者病程日记显示，Bridges组在患者信息、在为患者安排就诊时的适应性（就医便利性）（p<0.001）、医生选择（p = 0.020）、预约等待时间（p<0.001）以及更少的“中间状态”（患者对初级保健和二级保健之间不协调的体验）（p<0.001）方面有显著改善。在8个月时，两组在手术和医疗治疗率或全科诊所预约使用方面没有显著差异。Bridges组的（传统）医院门诊预约显著少于OSMC组（p<0.001）。
由全科诊所主导的综合护理模式可以显著减少门诊就诊次数，同时改善患者体验，并维持护理质量。
