Burn Damon, May Stephen, Edwards Lindsay
Trauma Orthopaedic and Musculoskeletal Services, Walsall Healthcare NHS Trust, Walsall, UK.
Physiother Res Int. 2014 Sep;19(3):176-85. doi: 10.1002/pri.1581. Epub 2014 Apr 4.
General practitioners' (GP) views about orthopaedic clinical assessment services (OCAS) managed by physiotherapists in the NHS have seldom been sought, yet GPs are likely to be key referrers to such a service.
This study aims to review GP views about an OCAS and how they believed the service could be improved.
Fifteen consenting GPs were interviewed utilizing semi-structured interviews and a standardized topic guide.
Interviews were recorded, transcribed and analysed for emergent themes. Interviews were analysed sequentially by date performed until saturation. Themes were discussed, and disagreements evaluated until agreement was found between the two main authors. The third author then analysed randomly selected interview transcripts and found no additional themes.
The study found GPs refer to specialist services, including this OCAS, because of wait times, locality, patient experience, GP experience and knowledge of available services. No GP identified they knew all possible orthopaedic referral routes.
GPs saw OCAS as another referral choice for patients suffering orthopaedic pathologies. GPs identified some difficulty in understanding the different services including the various professional roles involved. To assist with their understanding, they described requesting advertising of the different services and the clinicians involved or streamlining of services by provider services. Further detailed research addressing the limitations in this research design is indicated to investigate GP's thoughts and behaviours in relation to referral patterns especially as GPs in the UK took on commissioning for services from April 2013.
国民保健制度(NHS)中由物理治疗师管理的骨科临床评估服务(OCAS),很少征求全科医生(GP)的意见,然而全科医生很可能是此类服务的主要转诊者。
本研究旨在回顾全科医生对OCAS的看法以及他们认为该服务如何能够得到改进。
采用半结构化访谈和标准化主题指南,对15名同意参与的全科医生进行访谈。
对访谈进行录音、转录并分析其中出现的主题。访谈按进行日期依次分析,直至达到饱和状态。对主题进行讨论,评估不同意见,直至两位主要作者达成一致。第三位作者随后随机分析选定的访谈记录,未发现其他主题。
研究发现,由于等待时间、地点、患者体验、全科医生的经验以及对现有服务的了解,全科医生会将患者转诊至包括该OCAS在内的专科服务。没有全科医生表示他们了解所有可能的骨科转诊途径。
全科医生将OCAS视为骨科疾病患者的另一种转诊选择。全科医生在理解包括所涉及的各种专业角色在内的不同服务方面存在一些困难。为了帮助他们理解,他们描述了要求宣传不同服务以及所涉及的临床医生,或者由服务提供者简化服务流程。鉴于英国的全科医生自2013年4月起承担服务委托工作,需要针对本研究设计中的局限性开展进一步详细研究,以调查全科医生在转诊模式方面的想法和行为。