Morgan Simon, Tapley Amanda, Henderson Kim M, Spike Neil A, McArthur Lawrie A, Stewart Rebecca, Davey Andrew R, Dunlop Anthony, van Driel Mieke L, Magin Parker J
Elermore Vale General Practice, Newcastle, New South Wales, Australia.
GP Synergy, Mayfield, New South Wales, Australia.
J Prim Health Care. 2016 Dec;8(4):295-302. doi: 10.1071/HC16024.
INTRODUCTION Eye conditions are common presentations in Australian general practice, with the potential for serious sequelae. Pre-vocational ophthalmology training for General Practitioner (GP) trainees is limited. AIM To describe the rate, nature and associations of ophthalmic problems managed by Australian GP trainees, and derive implications for education and training. METHODS Cross-sectional analysis from an ongoing cohort study of GP trainees' clinical consultations. Trainees recorded demographic, clinical and educational details of consecutive patient consultations. Descriptive analyses report trainee, patient and practice demographics. Proportions of all problems managed in these consultations that were ophthalmology-related were calculated with 95% confidence intervals (CI). Associations were tested using simple logistic regression within the generalised estimating equations (GEE) framework. RESULTS In total, 884 trainees returned data on 184,476 individual problems or diagnoses from 118,541 encounters. There were 2649 ophthalmology-related problems, equating to 1.4% (95% CI: 1.38-1.49) of all problems managed. The most common eye presentations were conjunctivitis (32.5% of total problems), eyelid problems (14.9%), foreign body (5.3%) and dry eye (4.7%). Statistically significant associations were male trainee; male patient and patient aged 14 years or under; the problem being new and the patient being new to both trainee and practice; urban and of higher socioeconomic status practice location; the practice nurse not being involved; planned follow up not arranged; referral made; in-consultation information sought; and learning goals generated. DISCUSSION Trainees have comparable ophthalmology exposure to established GPs. However, associations with referral and information-seeking suggest GP trainees find ophthalmic problems challenging, reinforcing the critical importance of appropriate training.
引言
眼部疾病是澳大利亚全科医疗中常见的就诊问题，有可能导致严重的后遗症。全科医生（GP）实习生的职前眼科培训有限。
目的
描述澳大利亚GP实习生处理的眼科问题的发生率、性质及关联因素，并得出对教育和培训的启示。
方法
对一项正在进行的关于GP实习生临床会诊的队列研究进行横断面分析。实习生记录连续患者会诊的人口统计学、临床和教育细节。描述性分析报告实习生、患者和诊所的人口统计学特征。计算这些会诊中处理的所有问题中与眼科相关问题的比例，并给出95%置信区间（CI）。在广义估计方程（GEE）框架内使用简单逻辑回归检验关联因素。
结果
共有884名实习生返回了118541次会诊中184476个个体问题或诊断的数据。有2649个与眼科相关的问题，占所有处理问题的1.4%（95%CI：1.38 - 1.49）。最常见的眼部表现为结膜炎（占总问题的32.5%）、眼睑问题（14.9%）、异物（5.3%）和干眼症（4.7%）。具有统计学意义的关联因素有：男性实习生；男性患者以及14岁及以下患者；问题为新出现的，且患者对实习生和诊所来说都是新的；城市地区且社会经济地位较高的诊所地点；未涉及实习护士；未安排计划中的随访；进行了转诊；寻求了会诊中的信息；以及制定了学习目标。
讨论
实习生接触眼科问题的情况与经验丰富的全科医生相当。然而，与转诊和信息寻求的关联表明，GP实习生发现眼科问题具有挑战性，这凸显了适当培训的至关重要性。
