Ang K T, Ho B K, Mimi O, Salmah N, Salmiah M S, Noridah M S
Ang Kim Teng, MPH, Institute for Health Management, Jalan Rumah Sakit, Off Jalan Bangsar, 59200 Kuala Lumpur Malaysia Email:
Ho Bee Kiau, MMed (FamMed), Selangor Health Department, Malaysia
Malays Fam Physician. 2014 Dec 31;9(3):2-11. eCollection 2014.
Primary care providers play an important gatekeeping role in ensuring appropriate referrals to secondary care facilities. This cross-sectional study aimed to determine the level, pattern and rate of referrals from health clinics to hospitals in the public sector, and whether the placement of resident family medicine specialist (FMS) had made a significant difference. The study was carried out between March and April in 2012, involving 28 public primary care clinics. It showed that the average referral rate was 1.56% for clinics with resident FMS and 1.94% for those without resident FMS, but it was not statistically significant. Majority of referred cases were considered appropriate (96.1%). Results of the multivariate analysis showed that no prior consultation with senior healthcare provider and illnesses that were not severe and complex were independently associated with inappropriate referrals. Severity, complexity or uncertain diagnosis of patients' illness or injury significantly contributed to unavoidable referrals. Adequate facilities or having more experienced doctors could have avoided 14.5% of the referrals. The low referral rate and very high level of appropriate referrals could indicate that primary care providers in the public sector played an effective role as gatekeepers in the Malaysian public healthcare system.
基层医疗服务提供者在确保向二级医疗机构进行适当转诊方面发挥着重要的把关作用。这项横断面研究旨在确定公共部门健康诊所向医院转诊的水平、模式和比率，以及驻院家庭医学专科医生（FMS）的配置是否产生了显著差异。该研究于2012年3月至4月期间进行，涉及28家公共基层医疗诊所。结果显示，有驻院FMS的诊所平均转诊率为1.56%，没有驻院FMS的诊所平均转诊率为1.94%，但差异无统计学意义。大多数转诊病例被认为是适当的（96.1%）。多变量分析结果显示，未事先咨询高级医疗服务提供者以及病情不严重和不复杂的疾病与不适当转诊独立相关。患者疾病或损伤的严重程度、复杂性或诊断不确定性是不可避免转诊的重要因素。拥有足够的设施或更有经验的医生可避免14.5%的转诊。低转诊率和非常高的适当转诊水平可能表明，公共部门的基层医疗服务提供者在马来西亚公共医疗系统中作为把关人发挥了有效作用。
