Farr Matthew R B, Moraleda Deleito Javier, Xu Yanmin, Ray Jaydip
Department of Ear, Nose and Throat Surgery, Royal Hallamshire Hospital, Sheffield, UK.
J Eval Clin Pract. 2016 Feb;22(1):93-97. doi: 10.1111/jep.12442. Epub 2015 Aug 28.
RATIONALE, AIMS AND OBJECTIVES: The pressure to deliver quality care with finite resources means that dealing with single-symptom conditions like tinnitus in an efficient and individualized manner has never been more important. Both primary and secondary care practitioners have an obligation to explore efficient delivery of simple management pathways. Commissioners of health care are in a unique position to affect evidence-based strategic change in the management of uncomplicated tinnitus. This study is an attempt to explore one such option. We present the outcomes of a tinnitus patient pathway designed for one-stop management, thereby minimizing unnecessary additional appointments.
A retrospective observational cohort study of 452 patients referred to a NHS one-stop tinnitus clinic from 2008 to 2012. Clinical care guided was through the use of a structured approach to history taking, neurotological examination and management.
294 out of 452 (65%) of patients referred had unilateral tinnitus. The most common associated complaints were hearing loss (387/452, 86%) and hyperacusis (329/452, 73%). 210 (46%) of patients had their presenting complaint dealt with in a single clinic visit.
A structured system for referral and management of tinnitus within the health system ensures patients have timely access to evidence-based investigation and treatment. A consistent approach to imaging aimed at identifying retrocochlear pathology can benefit patients through early diagnosis of central pathology and the reassurance provided by a negative scan.
理论依据、目的和目标：在资源有限的情况下提供优质护理的压力意味着，以高效且个性化的方式处理耳鸣等单一症状疾病从未像现在这样重要。初级和二级医疗从业者都有义务探索简单管理途径的高效实施。医疗保健专员在影响耳鸣这种非复杂性疾病管理中基于证据的战略变革方面具有独特地位。本研究旨在探索一种这样的选择。我们展示了为一站式管理设计的耳鸣患者路径的结果，从而尽量减少不必要的额外预约。
对2008年至2012年转诊至英国国家医疗服务体系（NHS）一站式耳鸣诊所的452例患者进行回顾性观察队列研究。临床护理通过采用结构化的病史采集、耳神经学检查和管理方法来指导。
452例转诊患者中有294例（65%）患有单侧耳鸣。最常见的相关主诉是听力损失（387/452，86%）和听觉过敏（329/452，73%）。210例（46%）患者的主诉在一次门诊就诊中得到处理。
卫生系统内结构化的耳鸣转诊和管理系统可确保患者及时获得基于证据的检查和治疗。针对识别蜗后病变的一致影像学检查方法，可通过早期诊断中枢病变以及阴性扫描结果所提供的安心感使患者受益。
