Chenot J-F, Pieper A, Kochen M M, Himmel W
Abteilung Allgemeinmedizin, Universitätsmedizin Göttingen, Humboldtallee 38, 37073, Göttingen, Deutschland.
Schmerz. 2009 Apr;23(2):173-9. doi: 10.1007/s00482-009-0776-7.
Low back pain is a frequent reason for consultation in general practice. Many patients are treated in cooperation with an orthopaedic surgeon which requires an effective exchange of information. The aim of this study was to investigate the level of communication between general practitioners (GPs) and orthopaedic surgeons.
In this retrospective observational study referrals from GPs and corresponding response letters from orthopaedic surgeons were analyzed. GPs were asked to provide reasons for referral and to rate the quality of the response letters.
A total of 12 out of 82 GPs from the teaching network of the Medical School of Göttingen participated in the study. Of 911 referrals to ambulatory orthopaedic surgeons within 3 months, 34% (n=312) were referred for low back pain. GPs provided little information beyond a diagnosis on the referral contrary to their self-perception. Most referrals (61%) were initiated by patients and most of them were considered at risk for chronification (72%) by the referring GP. Despite a formal obligation to report back, GPs received a response letter for only one-third (114/312) of the patients. GPs rated most of them as satisfactory, however, 59% were unsatisfied with the treatment recommendations. Only 10% of the letters contained psychosocial details. The information provided in the orthopaedic response letters was heterogeneous and only partly fulfilled the criteria set by the Interdisciplinary Society for Orthopaedic Pain Management.
Incomplete and scant information on referral forms from GPs and a high non-response rate from orthopaedic surgeons suggest that current health care system and referral forms do not promote effective communication about the patient. This might explain the satisfaction of GPs with the orthopaedic response letters despite the lack of information. The GPs dissatisfaction with the treatment recommendations reflects the limited treatment options for chronic low back pain in ambulatory care.
下背痛是全科医疗中常见的就诊原因。许多患者会与骨科医生合作进行治疗，这需要有效的信息交流。本研究的目的是调查全科医生（GP）与骨科医生之间的沟通水平。
在这项回顾性观察研究中，分析了全科医生的转诊以及骨科医生相应的回复信。要求全科医生提供转诊原因并对回复信的质量进行评分。
哥廷根医学院教学网络中的82名全科医生中有12名参与了该研究。在3个月内转诊至门诊骨科医生的911例患者中，34%（n = 312）因下背痛转诊。与他们的自我认知相反，全科医生在转诊时除了诊断外提供的信息很少。大多数转诊（61%）由患者发起，其中大多数被转诊的全科医生认为有慢性化风险（72%）。尽管有正式的反馈义务，但全科医生仅收到三分之一（114/312）患者的回复信。全科医生对大多数回复信评价为满意，然而，59%对治疗建议不满意。只有10%的信件包含社会心理细节。骨科回复信中提供的信息参差不齐，仅部分符合骨科疼痛管理跨学科协会设定的标准。
全科医生转诊表上信息不完整且稀少，以及骨科医生的高无回复率表明，当前的医疗保健系统和转诊表不利于就患者情况进行有效沟通。这可能解释了尽管信息不足，全科医生仍对骨科回复信感到满意。全科医生对治疗建议的不满反映了门诊护理中慢性下背痛的治疗选择有限。
