Cervera Ixel, Boucai Laura, Andreopoulou Panagiota, Libutti Steven K, Hughes David T
Deparment of Surgery, Montefiore Medical Center, Bronx, New York.
Medicine-Division of Endocrinology, Memorial Sloan Kettering Cancer Center, New York, New York.
Endocr Pract. 2014 Jun;20(6):571-5. doi: 10.4158/EP13061.OR.
Referrals between physician specialties are common practice, and clear patterns develop. The increasing availability of high-volume endocrine surgery subspecialists with better outcomes may change these patterns. This study aimed to determine what factors influence endocrinologists' referral patterns for the surgical treatment of endocrine disease.
A national, cross-sectional, voluntary survey of members of the American Association of Clinical Endocrinologists examined physician demographics, physician's opinions on referral to endocrine surgery, preferred surgeon specialty, knowledge about surgeon characteristics, and how these factors influenced which surgeons they referred patients, as well as what changes in these factors would alter their referral patterns.
The survey response rate was 15% (73/500), and 97% were endocrinologists. On average, 0 to 5 patients/week were referred for surgery. Most respondents (91.8%) felt that endocrinologists should decide which surgeon to refer. General surgery was the preferred surgeon specialty (43.7%), and endocrine surgery was the preferred subspecialty (70.8%). The factors most often cited as very important in referral to a surgeon included surgeon outcome/complications (71%), familiarity with surgeon (65%), surgeon's communication with referring physician (61%), and surgeon volume (59%). The factors most often cited as likely to change physician referral patterns included patient satisfaction (62%), complication rates (57%), surgeon outcomes (54%), and surgeon volume (50%). The factors most often cited as unlikely to change referral patterns included new surgeon availability (70%) and hospital/surgeon advertising (58%).
Referring physicians want experienced endocrine surgeons with high operative volumes and good outcomes whom they are familiar with. The promotion of referral to high-volume surgeons requires communication, good outcomes, and satisfied patients.
不同内科专业之间的转诊是常见做法，且会形成明确模式。大量内分泌外科亚专科医生的出现及其更好的治疗效果可能会改变这些模式。本研究旨在确定哪些因素会影响内分泌科医生对内分泌疾病手术治疗的转诊模式。
对美国临床内分泌医师协会会员进行了一项全国性、横断面、自愿性调查，调查内容包括医生的人口统计学信息、医生对转诊至内分泌外科的看法、首选的外科医生专业、对外科医生特征的了解，以及这些因素如何影响他们转诊患者时选择哪位外科医生，还有这些因素的哪些变化会改变他们的转诊模式。
调查回复率为15%（73/500），97%为内分泌科医生。平均每周转诊0至5名患者进行手术。大多数受访者（91.8%）认为应由内分泌科医生决定转诊哪位外科医生。普通外科是首选的外科医生专业（43.7%），内分泌外科是首选的亚专科（70.8%）。在转诊给外科医生时最常被认为非常重要的因素包括外科医生的治疗效果/并发症（71%）、对外科医生的熟悉程度（65%）、外科医生与转诊医生的沟通（61%）以及外科医生的手术量（59%）。最常被认为可能改变医生转诊模式的因素包括患者满意度（62%）、并发症发生率（57%）、外科医生的治疗效果（54%）以及外科医生的手术量（50%）。最常被认为不太可能改变转诊模式的因素包括新的外科医生可获得性（70%）和医院/外科医生的广告宣传（58%）。
转诊医生希望转诊给经验丰富、手术量高且治疗效果好且他们熟悉的内分泌外科医生。推广转诊至手术量高的外科医生需要进行沟通、取得良好的治疗效果以及让患者满意。
