Department of Preventive Medicine, St Marianna University School of Medicine, Miyamae-ku, Kawasaki, Japan.
Health Policy Plan. 2010 Jul;25(4):319-27. doi: 10.1093/heapol/czp063. Epub 2009 Dec 22.
Injury is a growing public health concern worldwide. Since severe injuries require urgent treatment, involving smooth, timely patient referral between facilities, strengthening of the referral system would reduce injury mortality. Smooth referral consists of identification of severe cases, organization of transportation, communication between facilities and prompt care at the receiving facility. This study examined these components of referral of injured patients in a representative sample of health centres (HCs) and referral hospitals (RHs) in Cambodia. We analysed data from a survey carried out in 80 HCs and 17 RHs by interview or mailed questionnaire from December 2006 to April 2007. Collected information on referral included the presence of referral guidelines for injured patients, distance of referral, commonly used transportation and its cost, communication with receiving facilities, and fast-tracking at receiving facilities. Formal referral systems were not functioning well in some areas (insufficient communication and underutilization of ambulances), and informal systems were frequently involved (patient transfer by taxi or referral by community volunteers, and treatment by traditional healers) but were not fully integrated into the referral network (traditional healers seldom referred patients to public facilities). The referral distance was long for most of the surveyed facilities and transportation costs were high when transferring from remote areas, even by ambulance. This study identified the weaknesses and strengths of the emergency referral system in Cambodia. Streamlining referral mechanisms will require organization of each component of the referral mechanism by strengthening the existing system and mobilizing local resources, which would allow Cambodia to develop an efficient system at reasonable cost, though it may differ from Western models. Guidelines including these components along with training and supervision, and expansion of the system to cover other disease conditions, would strengthen the health care system as a whole in this country.
伤害是全球日益严重的公共卫生问题。由于重伤需要紧急治疗，需要在机构之间顺畅、及时地转介患者，因此加强转介系统可以降低伤害死亡率。顺畅的转介包括识别重伤病例、组织运输、机构间的沟通以及在接收机构得到及时治疗。本研究在柬埔寨有代表性的卫生中心（HC）和转诊医院（RH）样本中，调查了伤害患者转介的这些环节。我们分析了 2006 年 12 月至 2007 年 4 月期间通过访谈或邮寄问卷在 80 个 HC 和 17 个 RH 中进行的调查数据。收集的转介信息包括是否有伤害患者转介指南、转介距离、常用的运输方式及其费用、与接收机构的沟通以及接收机构的快速通道。在一些地区，正式的转介系统运行不畅（沟通不足，救护车使用不足），而非正式系统则经常介入（患者乘坐出租车或社区志愿者转介，以及传统治疗师治疗），但未完全纳入转介网络（传统治疗师很少将患者转介到公共机构）。对于大多数接受调查的机构来说，转介距离较长，即使使用救护车，从偏远地区转院的交通费用也很高。本研究确定了柬埔寨紧急转介系统的薄弱环节和优势。简化转介机制需要通过加强现有系统和调动当地资源来组织转介机制的各个环节，这将使柬埔寨能够以合理的成本开发出高效的系统，尽管它可能与西方模式不同。这些环节的指南包括培训和监督以及扩大系统覆盖其他疾病，将增强该国整体医疗保健系统。
