Jiwa Moyez, Dhaliwal Satvinder
Curtin University, Western Australia, Australia.
Qual Prim Care. 2012;20(1):39-45.
We aimed to explore if increasing the amount of relevant information relayed in referral letters between general practitioners (GPs) or family physicians and hospital specialists helps in the scheduling of appointments for patients. We report a before and after study comparing outcomes before and after the introduction of software to assist referral writing.
The participants were GPs and hospital specialists based in metropolitan Perth, Western Australia. The amount of relevant information in referral letters from GPs was assessed with reference to a published schedule three months before and four months after deploying interactive computerised Referral Writer software (RW). The longer period after deploying the RW was to allow GPs time to become familiar with the RW. The letters were scored by a researcher for the amount of relevant information included and then independently assessed by two specialists in each of six specialties to determine if they were able to decide which patients needed to be seen soonest and what was the most likely outcome of the specialist consultation. The actual diagnosis for each case was recorded later to assess if there was an association between the amount of relevant information relayed and the diagnosis of life limiting or other pathologies.
Each GP referred 5.6 patients on average, range (1, 14) before the RW and 4.8 patients, range (0, 14) after the RW. The amount of relevant information in the letters improved substantially after the RW, mean difference 37%, 95% Confidence Interval 43-30%, P <0.001. For 91% of letters after the RW, both specialists in each specialty were confident or very confident that they had enough information to decide when the patient should come to their clinic; this had increased from 50% before the RW, P = 0.001. There was no association observed between the amount of relevant information relayed and the final diagnosis.
Standardising and using electronic communications to refer appears to facilitate rational scheduling of specialist appointments. Comprehensive referral may help to ensure that the right patients are seen by the specialist sooner rather than later.
我们旨在探讨增加全科医生（GP）或家庭医生与医院专科医生之间转诊信中传递的相关信息量是否有助于为患者安排预约。我们报告了一项前后对照研究，比较了引入辅助转诊书写软件前后的结果。
参与者为西澳大利亚州珀斯市的全科医生和医院专科医生。在部署交互式计算机化转诊书写软件（RW）前三个月和后四个月，参照已发布的清单评估全科医生转诊信中的相关信息量。部署RW后较长的时间段是为了让全科医生有时间熟悉RW。由一名研究人员对信件中包含的相关信息量进行评分，然后由六个专科中的两名专科医生分别独立评估，以确定他们是否能够决定哪些患者需要尽快就诊以及专科会诊最可能的结果是什么。随后记录每个病例的实际诊断结果，以评估传递的相关信息量与危及生命或其他病症的诊断之间是否存在关联。
每位全科医生在使用RW前平均转诊5.6名患者，范围为（1, 14）名，使用RW后平均转诊4.8名患者，范围为（0, 14）名。使用RW后，信件中的相关信息量有显著改善，平均差异为37%，95%置信区间为43 - 30%，P <0.001。在使用RW后的信件中，每个专科的两名专科医生中有91%对他们有足够信息决定患者何时应到其诊所就诊表示有信心或非常有信心；这一比例从使用RW前的50%有所增加，P = 0.001。未观察到传递的相关信息量与最终诊断之间存在关联。
标准化并使用电子通信进行转诊似乎有助于合理安排专科预约。全面的转诊可能有助于确保合适的患者尽早而非推迟就诊于专科医生。
