Rutten Martijn Hendrik, Smits Marleen, Peters Yvonne Anthonia Sebastiana, Assendelft Willem Jan Jozef, Westert Gert Pieter, Giesen Paul Hendrikus Josephus
Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands.
Fam Pract. 2018 May 23;35(3):253-258. doi: 10.1093/fampra/cmx093.
In the Netherlands, out-of-hours primary care is provided in general-practitioner-cooperatives (GPCs). These are increasingly located on site with emergency departments (ED), forming Emergency-Care-Access-Points (ECAP). A more efficient and economical organization of out-of-hours primary emergency care could be realized by increased collaboration at an ECAP. In this study, we compared the effects of different models with respect to access to (hospital) radiology by the GPC. We investigated patient and care characteristics, indication for diagnostics and outcomes at GPCs with and without access to radiology.
A prospective observational record review study of patients referred for conventional radiology for trauma by one of five GPCs in the period April 2014-October 2015, covering three organizational models.
The mean age was 31 years and 56% was female. Extremities were predominately involved (91%). There was a medical indication for radiology in 85% and the assessed risk by requesting GPs on abnormalities was high in 66%. There was a significant difference in outcomes between models. Radiological abnormalities (fractures/luxations) were present in 51% without direct access and in 35% with partial and unlimited access. Overall, 61% of the included patients were referred to the ED; 100% in the models without access and 38% in the models with (partial) access.
GPC access to radiology is beneficial for patients and professionals. The diagnostics were adequately used. With access to radiology, unnecessary referrals and specialist care are prevented. This may lead to a decrease in ED attendance and overcrowding.
在荷兰，非工作时间的初级医疗服务由全科医生合作社（GPCs）提供。这些合作社越来越多地与急诊科（ED）设在同一地点，形成了紧急护理接入点（ECAP）。通过在紧急护理接入点加强合作，可以实现更高效、经济的非工作时间初级紧急护理组织。在本研究中，我们比较了不同模式下全科医生合作社使用（医院）放射科服务的效果。我们调查了有无放射科服务的全科医生合作社的患者和护理特征、诊断指征及结果。
对2014年4月至2015年10月期间由五个全科医生合作社之一转诊进行创伤常规放射检查的患者进行前瞻性观察记录回顾研究，涵盖三种组织模式。
患者平均年龄为31岁，56%为女性。主要累及四肢（91%）。85%的患者有放射科检查的医学指征，请求全科医生评估异常情况的风险较高的占66%。不同模式的结果存在显著差异。无直接放射科服务时，51%的患者存在放射学异常（骨折/脱位）；有部分和无限制放射科服务时，这一比例为35%。总体而言，纳入研究的患者中有61%被转诊至急诊科；无放射科服务模式下为100%，有（部分）放射科服务模式下为38%。
全科医生合作社使用放射科服务对患者和专业人员有益。诊断服务得到了充分利用。有了放射科服务，可避免不必要的转诊和专科护理。这可能会减少急诊科就诊人数和拥挤情况。
