Gjessing Kristian, Faresjö Tomas
Faculty of Health Sciences, Linköping University, Linköping, Sweden.
Rural Remote Health. 2009 Jan-Mar;9(1):975. Epub 2009 Feb 4.
A patient's needs and the seriousness of the disease are not the only factors that determine referral to hospital. The objective of this study was to analyse whether locum doctors (LDs) have a different pattern of referral to hospital from regular GPs (RGPs).
All hospital referrals for one year (n = 5566 patients) from two Norwegian rural primary health care (PHC) centres to the nearby district hospital were analysed with regard to ICD-10 diagnosis groups. A major difference between the PHCs was that one had a continuous supply of LDs while the other had a stable group of RGPs. The equal-sized communities were demographically and socio-culturally similar.
The PHC centre mainly operated by short-term LDs referred a relatively high number of patients to the district hospital within the diagnosis groups of chapter VI 'Diseases of the nervous system' (proportionate referral rate 210%; p = 0.010), and chapter IX 'Diseases of the circulatory system' (proportionate referral rate 130%; p = 0.048), and a comparatively low number of patients for the diagnostic groups in chapter X 'Diseases of the respiratory system' (p = 0.018), and chapter XIV 'Diseases of the genitourinary system' (p = 0.039), compared with the norm of the district hospital's total population. The number and proportion of the total number of referrals, adjusted for population size, did not differ between the two rural communities. The LD-run PHC centre differed significantly from the total norm in 5 out of 19 ICD chapters, equal to 41% of the patients.
Only one significant difference in hospital referrals related to ICD-diagnoses groups were found between the studied rural PHC centres, but the LD-run PHC differed from the total norm. These differences could neither be explained from the district's consumption of somatic hospital care nor the demographical differences, but were related to staffing at the PHC, that is LDs or RGPs. The analysis also revealed that possible under- and/or over-diagnosing of certain diseases occurred, both having potential medical consequences for the patient, as well as increasing healthcare expenditure.
患者需求和疾病严重程度并非决定转诊至医院的唯一因素。本研究的目的是分析临时代理医生（LDs）与常规全科医生（RGPs）在转诊至医院方面是否存在不同模式。
对挪威两个农村初级卫生保健（PHC）中心一年内向附近地区医院转诊的所有病例（n = 5566例患者）按照国际疾病分类第十版（ICD - 10）诊断组进行分析。这两个初级卫生保健中心的一个主要差异在于，其中一个有临时代理医生持续坐诊，而另一个有一组稳定的常规全科医生。两个规模相当的社区在人口统计学和社会文化方面相似。
主要由短期临时代理医生运作的初级卫生保健中心，在第六章“神经系统疾病”诊断组内向地区医院转诊的患者数量相对较多（比例转诊率210%；p = 0.010），以及第九章“循环系统疾病”（比例转诊率130%；p = 0.048），而在第十章“呼吸系统疾病”（p = 0.018）和第十四章“泌尿生殖系统疾病”（p = 0.039）诊断组中转诊的患者数量相对较少，与地区医院总人口的标准相比。经人口规模调整后的转诊总数及比例在两个农村社区之间并无差异。在19个ICD章节中的5个章节里，临时代理医生运作的初级卫生保健中心与总体标准存在显著差异，这部分患者占比41%。
在所研究的农村初级卫生保健中心之间，仅发现与ICD诊断组相关的医院转诊存在一处显著差异，但临时代理医生运作的初级卫生保健中心与总体标准不同。这些差异既无法从该地区的躯体医院护理消耗情况来解释，也不能从人口统计学差异来解释，而是与初级卫生保健机构的人员配置有关，即临时代理医生或常规全科医生。分析还表明，某些疾病可能存在诊断不足和/或诊断过度的情况，这对患者既有潜在的医疗后果，也会增加医疗保健支出。
