巴伐利亚城市初级保健非工作时间服务中就诊原因及精神疾病共病情况——一项横断面研究的结果

Reasons for encounters and psychiatric comorbidity in an urban Bavarian primary care out-of-hour service - results of a cross sectional study.

作者信息

Storr Constanze, Gahbler Lucia Marieke, Linde Klaus, Schneider Antonius

机构信息

Institute of General Practice, University Hospital Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, 81667, Munich, Germany.

出版信息

BMC Health Serv Res. 2017 Nov 28;17(1):783. doi: 10.1186/s12913-017-2749-3.

DOI:10.1186/s12913-017-2749-3

PMID:29183310

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5704587/

Abstract

BACKGROUND

International studies have shown a contribution of psychiatric comorbidity to high utilization rates in out-of-hour primary care (OOHC). Up to now, the impact of psychiatric comorbidity in German OOHC remains unclear. Therefore, we aimed to investigate reasons for encounter (RFE), possible psychiatric comorbidity, utilization rates, and a possible association between utilization rate and psychiatric comorbidity among patients of an urban OOHC unit.

METHODS

In a cross-sectional, prospective, naturalistic study five hundred self-referred patients completed a self-designed questionnaire addressing RFE, past office visits and personal information. Additionally, we employed three validated questionnaires (PHQ-9, PHQ-15 and GAD-7) to screen for mental disorders. We collected information about past visits through computerized patients' charts. Diagnoses were classified according to the International Classification of Primary Care-2.

RESULTS

The most frequent RFE were musculoskeletal complaints (36%), followed by respiratory diseases (13%), gastrointestinal problems (10%), skin conditions (8%) and urologic ailments (6%). Of the included patients 58% were working fulltime and 61% had greater than or equal to 10 years of education. The mean age was 37.3 in females and 40.5 years in males. Prevalence of psychiatric comorbidity was 27%. Only 3% visited the office more than twice over a 12 months period. We could not find an association between high utilization and psychiatric comorbidity.

CONCLUSION

In this study, musculoskeletal complaints were the most frequent RFE. Patients were predominantly young, employed and educated. The prevalence of psychiatric comorbidity was similar to the prevalence in common general practitioner offices and showed no significant relation to frequent attendance. This information might help to prepare physicians better for patient care in OOHC.

摘要

背景

国际研究表明，精神疾病合并症是导致非工作时间初级医疗服务（OOHC）高利用率的一个因素。到目前为止，精神疾病合并症对德国OOHC的影响仍不明确。因此，我们旨在调查城市OOHC机构患者的就诊原因（RFE）、可能存在的精神疾病合并症、利用率，以及利用率与精神疾病合并症之间可能存在的关联。

方法

在一项横断面、前瞻性、自然主义研究中，500名自我转诊患者完成了一份自行设计的问卷，内容涉及RFE、过去的门诊就诊情况和个人信息。此外，我们使用了三份经过验证的问卷（PHQ-9、PHQ-15和GAD-7）来筛查精神障碍。我们通过计算机化的患者病历收集过去就诊的信息。诊断按照《国际初级保健分类-2》进行分类。

结果

最常见的RFE是肌肉骨骼疾病（36%），其次是呼吸系统疾病（13%）、胃肠道问题（10%）、皮肤疾病（8%）和泌尿系统疾病（6%）。纳入的患者中，58%为全职工作，61%接受过10年及以上教育。女性的平均年龄为37.3岁，男性为40.5岁。精神疾病合并症的患病率为27%。在12个月内，只有3%的患者就诊次数超过两次。我们未发现高利用率与精神疾病合并症之间存在关联。