Lim Sern Chin, Allen Roger C, Munro Jane E, Akikusa Jonathan D
Rheumatology Service, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2012 May;48(5):439-42. doi: 10.1111/j.1440-1754.2011.02243.x. Epub 2011 Nov 16.
Despite a move towards the provision of specialist training in Australia in settings that extend beyond the public hospital system, formal comparisons of case mix between public and private specialty clinics have rarely been performed. It is therefore unclear for many specialties how well training in one setting prepares trainees for practice in the other.
This study aims to compare the case mix of paediatric rheumatology patients seen in public and private settings and the referral sources of patients in each.
An audit of all new patients seen in the public and private paediatric rheumatology clinics on campus at Royal Children's Hospital between June 2009 and January 2011. Data related to demographics, primary diagnosis, referral source and location seen were abstracted and compared.
Eight hundred and seventy-six new patients were seen during the period of interest. Of these, 429 patients (48.9%) were seen in private clinics. The commonest diagnostic categories for both type of clinics were non-inflammatory musculoskeletal pain/orthopaedic conditions (public 39.4%, private 33.6%) followed by juvenile idiopathic arthritis (public 16.6%, %, private 18.6%), other skin/soft tissue disorders (public 8.7%, private 9.6%) and pain syndromes (public 4.9%, private 11.4%). Patients with haematological and vasculitic disorders were predominantly seen in public clinics. The commonest source of referrals to both clinics was general practitioners (public 40.6%, private 53.1%).
The case mix in private paediatric rheumatology clinics closely mirrors that of public clinics at our centre. Training in either setting would provide sufficient case-mix exposure to prepare trainees for practice in the other.
尽管澳大利亚已朝着在公立医院系统以外的环境中提供专科培训的方向发展，但公立和私立专科诊所之间病例组合的正式比较却很少进行。因此，对于许多专科来说，不清楚在一种环境中的培训能在多大程度上让学员为在另一种环境中执业做好准备。
本研究旨在比较公立和私立环境中儿科风湿病患者的病例组合以及各环境中患者的转诊来源。
对2009年6月至2011年1月期间在皇家儿童医院校园内的公立和私立儿科风湿病诊所就诊的所有新患者进行审计。提取并比较了与人口统计学、初步诊断、转诊来源和就诊地点相关的数据。
在感兴趣的时间段内共诊治了876名新患者。其中，429名患者（48.9%）在私立诊所就诊。两种诊所最常见的诊断类别均为非炎性肌肉骨骼疼痛/骨科疾病（公立39.4%，私立33.6%），其次是幼年特发性关节炎（公立16.6%，私立18.6%）、其他皮肤/软组织疾病（公立8.7%，私立9.6%）和疼痛综合征（公立4.9%，私立11.4%）。血液学和血管炎疾病患者主要在公立诊所就诊。两个诊所最常见的转诊来源均为全科医生（公立40.6%，私立53.1%）。
我们中心私立儿科风湿病诊所的病例组合与公立诊所极为相似。在任何一种环境中的培训都能让学员有足够的病例接触，为在另一种环境中执业做好准备。
