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在前往急诊科之前先去看全科医生会改变患者的治疗结果吗?一项对伦敦市中心一家全科诊所的描述性观察研究。

Does attending general practice prior to the emergency department change patient outcomes? A descriptive, observational study of one central London general practice.

作者信息

Morton S, Hames R, Kelso I, Newth A, Gnani S

机构信息

North Kensington Medical Centre, London, UK.

Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.

出版信息

London J Prim Care (Abingdon). 2017 Jan 23;9(3):28-32. doi: 10.1080/17571472.2017.1280893. eCollection 2017 May.

Abstract

BACKGROUND

The challenge of keeping Emergency Department (ED) attendances down continues and timely access to general practice (GP) is often portrayed as a potential solution.

SETTING

One London general practice (registered population = 4900).

QUESTION

Does seeing a GP before attending the ED affect the outcome of a patient's ED care?

METHODS

Routine clinical data were extracted using SystmOne primary care computer system for all registered patients with an ED attendance between 1 October 2014 and 31 September 2015. The scanned discharge summaries from the ED and GP notes were reviewed and outcome measures extracted.

RESULTS

227 patients (121 female; 104 male) attended the ED. The most common presentation was abdominal pain ( = 11). 25% of patients had seen ( = 50), or contacted by phone ( = 6), a GP about the same presenting complaint before attending the ED. Of those, 73% ( = 41/56) were referred to the ED and 49% ( = 20/41) were admitted versus 33% ( = 60/184) who self-presented (statistically significant,  = 0.05). An additional 32% of those who saw the GP first ( = 13/41) received specialist ED treatment.

DISCUSSION/CONCLUSION: Only 25% of patients see their GP prior to attending the ED. The majority of patients who were referred by their GP required admission or specialised ED treatment. It remains unclear why the majority of patients did not choose to contact their GP prior to attending the ED, despite urgent appointments being offered; research into patients' health beliefs in this group is required for greater understanding.

摘要

背景

降低急诊科就诊人数的挑战依然存在,及时获得全科医疗服务通常被视为一种潜在的解决方案。

地点

伦敦的一家全科诊所(注册人口 = 4900)。

问题

在前往急诊科之前看全科医生是否会影响患者在急诊科的治疗结果?

方法

使用SystmOne基层医疗计算机系统提取2014年10月1日至2015年9月31日期间所有前往急诊科就诊的注册患者的常规临床数据。审查了急诊科的扫描出院小结和全科医生记录,并提取了结果指标。

结果

227名患者(121名女性;104名男性)前往急诊科就诊。最常见的症状是腹痛(n = 11)。25%的患者在前往急诊科之前就同一主诉看过全科医生(n = 50)或通过电话联系过全科医生(n = 6)。其中,73%(n = 41/56)被转诊至急诊科,49%(n = 20/41)被收治,而自行前往急诊科的患者中这一比例为33%(n = 60/184)(具有统计学意义,P = 0.05)。另外,首次看全科医生的患者中有32%(n = 13/41)接受了急诊科专科治疗。

讨论/结论:只有25%的患者在前往急诊科之前看了全科医生。大多数由全科医生转诊的患者需要住院或接受急诊科专科治疗。目前尚不清楚为什么大多数患者在前往急诊科之前没有选择联系他们的全科医生,尽管提供了紧急预约;需要对这组患者的健康观念进行研究,以加深理解。

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