Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Fam Pract. 2019 Jul 31;36(4):493-500. doi: 10.1093/fampra/cmy083.
The world has an ageing population. Infection is common in older adults; serious infection has a high mortality rate and is associated with unplanned admissions. In the UK, general practitioners (GPs) must identify which older patients require admission to hospital and provide appropriate care and support for those staying at home.
To explore attitudes of UK GPs towards referring older patients with suspected infection to hospital, how they weigh up the decision to admit against the alternatives and how alternatives to admission could be made more effective.Methods. Qualitative study using semi-structured interviews. GPs were purposively sampled from across the UK to achieve maximum variation in terms of GP role, experience and practice population. Interview transcripts were coded and analysed using a modified framework approach.
GPs' key influences on decision making were grouped into patient, GP and system factors. Patient factors included clinical factors, social factors and shared decision making. GP factors included gut instinct, risk management and acknowledging an associated personal emotional burden. System factors involved weighing up the pressure on secondary care beds against increasing GP workload. GPs described that finding an alternative to admission could be more time consuming, complex to arrange or were restricted by lack of capacity.
GPs need to be empowered to make safe decisions about place of care for older adults with suspected infection. This may mean developing strategies to support decision making as well as improving the ease of access to, and capacity of, any alternatives to admission.
世界人口老龄化。感染在老年人中很常见；严重感染的死亡率很高，并与非计划性入院有关。在英国，全科医生（GP）必须确定哪些老年患者需要住院，并为在家的患者提供适当的护理和支持。
探讨英国全科医生对疑似感染的老年患者转院的态度，他们如何权衡入院决策与替代方案的利弊，以及如何使替代方案更有效。
采用半结构式访谈的定性研究。从英国各地有针对性地抽取全科医生，以实现全科医生角色、经验和实践人群的最大差异。使用修改后的框架方法对访谈记录进行编码和分析。
影响决策的关键因素分为患者、全科医生和系统因素。患者因素包括临床因素、社会因素和共同决策。全科医生因素包括直觉、风险管理和承认相关的个人情感负担。系统因素涉及权衡二级保健床位的压力与不断增加的全科医生工作量。全科医生描述说，寻找替代入院的方法可能更耗时、安排更复杂，或者受到能力不足的限制。
需要赋予全科医生权力，使其能够为疑似感染的老年患者做出安全的护理地点决策。这可能意味着制定支持决策的策略，以及改善获得替代入院方案的便利性和能力。
