Center for Innovation in Access and Quality, Department of Medicine, San Francisco General Hospital, University of California, San Francisco, CA 94110, USA.
Am J Med. 2013 Jun;126(6):523-8. doi: 10.1016/j.amjmed.2012.12.019. Epub 2013 Apr 15.
Preconsultation exchange is an emerging model of specialty care proposed by the American College of Physicians that seeks to answer a clinical question without a formal patient visit to the specialty clinic. This form of specialty care has been little studied. We sought to determine the appropriateness of preconsultation exchange for ambulatory hepatology consultations within our urban health care system.
Retrospective study of referrals for ambulatory hepatology consultation in the safety net health care system of San Francisco, Calif from January 2007 through April 2010.
Of the 500 referrals reviewed, 87 were excluded as repeat requests. The most common reasons for referral were hepatitis B (34.9%) and hepatitis C (32.0%). Fifty-six referrals (13.6%) were appropriate for preconsultation exchange, and 190 (46.0%) were inappropriate for preconsultation exchange. One hundred sixty-seven (40.4%) referrals did not include enough information to determine appropriateness for preconsultation exchange. Most of these (83.8%) were made for hepatitis B or hepatitis C, despite the presence of explicit referral guidelines. Midlevel providers were more likely than physicians to provide enough information to determine appropriateness for preconsultation exchange.
In our urban health care system, preconsultation exchange appears to be an appropriate form of specialty care for some ambulatory hepatology consultations. Communication between primary care provider and specialist appears to be an important barrier to broader implementation of preconsultation exchange. Optimizing the preconsultation exchange is critical to improve the primary-specialty care interface, and to build a true Patient-Centered Medical Home Neighborhood.
预咨询交流是美国医师学院提出的一种新兴的专业护理模式，旨在在不进行专科门诊就诊的情况下回答临床问题。这种形式的专科护理研究甚少。我们试图确定在我们的城市医疗保健系统中，预咨询交流是否适合门诊肝脏病学咨询。
回顾性研究了 2007 年 1 月至 2010 年 4 月期间加利福尼亚州旧金山的安全网医疗保健系统中门诊肝脏病学咨询的转诊情况。
在审查的 500 份转诊中，有 87 份因重复请求而被排除在外。转诊的最常见原因是乙型肝炎（34.9%）和丙型肝炎（32.0%）。56 份转诊（13.6%）适合预咨询交流，190 份转诊（46.0%）不适合预咨询交流。167 份转诊（40.4%）没有足够的信息来确定是否适合预咨询交流。其中大多数（83.8%）是针对乙型肝炎或丙型肝炎的，尽管有明确的转诊指南。中级保健提供者比医生更有可能提供足够的信息来确定是否适合预咨询交流。
在我们的城市医疗保健系统中，预咨询交流似乎是某些门诊肝脏病学咨询的一种合适的专业护理形式。初级保健提供者和专科医生之间的沟通似乎是更广泛实施预咨询交流的一个重要障碍。优化预咨询交流对于改善初级保健与专科医疗的衔接，以及建立真正的以患者为中心的医疗之家社区至关重要。
