Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of General Practice, Berlin, Germany.
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Division of Emergency Medicine, Berlin, Germany.
BMJ Open. 2019 Apr 2;9(4):e026786. doi: 10.1136/bmjopen-2018-026786.
Patients with acute symptoms present not only to general practitioners (GPs), but also frequently to emergency departments (EDs). Patients' decision processes leading up to an ED self-referral are complex and supposed to result from a multitude of determinants. While they are key providers in primary care, little is known about GPs' perception of such patients. This qualitative study explores the GPs' view regarding motives and competences of patients self-referring to EDs, and also GPs' rationale for or against physician-initiated ED referrals.
Qualitative study with semi-structured, face-to-face interviews; qualitative content analysis.
GP practices in Berlin, Germany.
15 GPs (female/male: 9/6; mean age 53.6 years).
The interviewed GPs related a wide spectrum of factors potentially influencing their patients' decision to visit an ED, and also their own decision-making in potential referrals. Considerations go beyond medical urgency. Statements concerning patients' surmised rationale corresponded to GPs' reasoning in a variety of important areas. For one thing, the timely availability of an extended spectrum of diagnostic and therapeutic options may make ED services attractive to both. Access difficulties in the ambulatory setting were mentioned as additional triggers for an ED visit initiated by a patient or a GP. Key patient factors like severity of symptoms and anxiety also play a major role; a desire for reassurance may lead to both self-referred and physician-initiated ED visits. Patients' health competence was prevailingly depicted as limited, with the internet as an important influencing factor. Counselling efforts by GP were described as crucial for improving health literacy.
Health education could hold promise when aiming to reduce non-urgent ED consultations. Primary care providers are in a key position here. Amelioration of organisational shortages in ambulatory care, for example, limited consultation hours, might also make an important impact, as these trigger both self-referrals and GP-initiated ED referrals.
DRKS00011930.
有急性症状的患者不仅会去看全科医生（GP），也会经常去急诊部（ED）。患者前往 ED 就诊的决策过程是复杂的，应该是由多种因素决定的。虽然他们是初级保健的主要提供者，但对于 GP 对这些患者的看法知之甚少。这项定性研究探讨了 GP 对患者自行前往 ED 的动机和能力的看法，以及 GP 对或反对医生发起 ED 转诊的理由。
半结构化、面对面访谈的定性研究；定性内容分析。
德国柏林的全科医生诊所。
15 名 GP（女性/男性：9/6；平均年龄 53.6 岁）。
接受采访的 GP 讲述了一系列可能影响患者前往 ED 就诊的因素，以及他们自己在潜在转诊中的决策。考虑因素不仅仅是医疗紧急情况。关于患者推测的理由的陈述与 GP 在许多重要领域的推理相对应。一方面，扩展的诊断和治疗选择的及时可用性可能会使 ED 服务对两者都具有吸引力。在门诊环境中遇到的就诊困难被提及为患者或 GP 发起的 ED 就诊的额外触发因素。主要的患者因素，如症状的严重程度和焦虑，也起着重要作用；寻求安慰可能会导致患者自行前往和医生发起的 ED 就诊。患者的健康能力普遍被描述为有限的，互联网是一个重要的影响因素。GP 的咨询工作被描述为提高健康素养的关键。
当旨在减少非紧急 ED 就诊时，健康教育可能有希望。初级保健提供者在这里处于关键地位。改善门诊护理中的组织短缺，例如，有限的咨询时间，也可能会产生重要影响，因为这些因素会同时引发患者自行前往和 GP 发起的 ED 就诊。
DRKS00011930。
