Schols Angel M R, Stevens Femke, Zeijen Camiel G I P, Dinant Geert-Jan, van Vugt Christel, Cals Jochen W L
a Department of Family Medicine, School for Public Health and Primary Care (CAPHRI) , Maastricht University , the Netherlands ;
b InEen , Utrecht , the Netherlands.
Eur J Gen Pract. 2016 Sep;22(3):176-81. doi: 10.1080/13814788.2016.1189528. Epub 2016 Jun 30.
In general practice, excluding serious conditions is one of the cornerstones of the consultation. Diagnostic tests are widely used to assist the decision-making process in these cases. Little is known about general practitioners' (GPs) access to diagnostic tests at GP out-of-hours services.
To determine GPs' access to diagnostic tests-imaging, function tests, laboratory tests, and point-of-care tests (POCT)-during GP out-of-hours care and to assess whether access to diagnostic facilities differs between services located adjacent to or separate from an accident and emergency (A&E) department.
Cross-sectional survey of all 117 GP out-of-hours services in the Netherlands in 2014.
One-hundred-seventeen GP out-of-hours services participated in the survey; response rate 100%. Access to diagnostic tests during GP out-of-hours care varied across services, although generally there was limited access. Electrocardiography was available in 26% (30/117) of all services, conventional radiography in 19% (22/117), laboratory tests between 37% (43/117) and 65% (76/117). All services had glucose POCT and urine dipstick tests available while none utilized troponin POCT. We observed no relevant differences in access to diagnostic tests between services adjacent to or separate from an A&E department.
GPs in the Netherlands had limited and varying access to diagnostic tests during GP out-of-hours care in 2014. Out-of-hours services adjacent to A&E departments do not offer wider access to diagnostic tests. Further research on the accessibility of diagnostic tests in other European countries with similar and different GP out-of-hours care systems could shed further light on the effects of accessibility to diagnostic tests. [Box: see text].
在全科医疗中，排除严重疾病是诊疗的基石之一。诊断性检查被广泛用于协助此类情况下的决策过程。对于全科医生（GP）在非工作时间服务中获取诊断性检查的情况，我们知之甚少。
确定全科医生在非工作时间诊疗期间获取诊断性检查（影像检查、功能检查、实验室检查和即时检验（POCT））的情况，并评估与急诊科（A&E）相邻或独立的服务机构在获取诊断设施方面是否存在差异。
2014年对荷兰所有117家全科医生非工作时间服务机构进行横断面调查。
117家全科医生非工作时间服务机构参与了调查；回复率为100%。全科医生非工作时间诊疗期间获取诊断性检查的情况因服务机构而异，不过总体而言获取机会有限。所有服务机构中，26%（30/117）可进行心电图检查，19%（22/117）可进行传统放射检查，实验室检查的比例在37%（43/117）至65%（76/117）之间。所有服务机构均提供血糖POCT和尿试纸检查，而无一使用肌钙蛋白POCT。我们观察到，与急诊科相邻或独立的服务机构在获取诊断性检查方面没有相关差异。
2014年，荷兰的全科医生在非工作时间诊疗期间获取诊断性检查的机会有限且各不相同。与急诊科相邻的非工作时间服务机构并未提供更广泛的诊断性检查获取机会。对其他具有类似和不同全科医生非工作时间诊疗系统的欧洲国家诊断性检查可及性的进一步研究，可能会进一步揭示诊断性检查可及性的影响。[方框：见正文]
