盆底功能障碍女性在转诊至泌尿妇科亚专科之前，初级保健医生和专科医生的治疗模式。

Treatment patterns of primary care physicians specialists prior to subspecialty urogynaecology referral for women suffering from pelvic floor disorders.

作者信息

Prentice Abigail, Bazzi Ali Ahmad, Aslam Muhammad Faisal

机构信息

Department of Family Medicine, Marquette Health System, Marquette, MI 49855, United States.

Department of Obstetrics and Gynaecology, St. John Hospital and Medical Center, MI 48236, United States.

出版信息

World J Methodol. 2019 Jun 28;9(2):26-31. doi: 10.5662/wjm.v9.i2.26.

DOI:10.5662/wjm.v9.i2.26

PMID:31367545

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6658364/

Abstract

BACKGROUND

There are approximately 25% of women in the United States suffering from pelvic floor disorders (PFDs) and this number is predicted to rise. The potential complications and increasing healthcare costs that exist with an operation indicate the importance of conservative treatment options prior to attempting surgery. Considering the prevalence of PFDs, it is important for primary care physician and specialists (obstetricians and gynecologists) to be familiar with the initial work-up and the available conservative treatment options prior to subspecialist (urogynecologist) referral.

AIM

To assess the types of treatments that specialists attempted prior to subspecialty referral and determine the differences in referral patterns.

METHODS

This is a retrospective cohort study of 234 patients from a community teaching hospital referred to a single female pelvic medicine and reconstructive surgery (FPMRS) provider for PFD. Specialist primary care provider (PCP) referrals were compared. Number, length and treatment types were studied using descriptive statistics.

RESULTS

There were 184 referrals (78.6%) by specialists and 50 (21.4%) by PCP. Treatment (with Kegel exercises, pessary placements, and anticholinergic medications) was attempted on 51% ( 26) of the PCP compared to 48% ( = 88) of the specialist referrals prior to FPMRS referral ( 0.6). There was no significant difference in length of treatment prior to referral for PCPs specialists (14 mo 16 mo, respectively, 0.88). However, there was a significant difference in the patient's average time with the condition prior to referral (35 mo 58 mo for PCP compared to specialist referrals) ( 0.02).

CONCLUSION

One half of the patients referred to FPMRS clinic received treatment prior to referral. Thus, specialists and generalists can benefit from education regarding therapies for PFD before subspecialty referral.

摘要

背景

在美国，约25%的女性患有盆底功能障碍（PFDs），且这一数字预计还会上升。手术存在的潜在并发症及不断增加的医疗费用表明，在尝试手术前采用保守治疗方案很重要。鉴于PFDs的患病率，初级保健医生和专科医生（妇产科医生）在将患者转诊至专科医生（女性盆底医学与重建外科医生）之前，熟悉初始检查及可用的保守治疗方案非常重要。

目的

评估专科医生在转诊至专科之前尝试的治疗类型，并确定转诊模式的差异。

方法

这是一项对来自社区教学医院的234例因PFD转诊至单一女性盆底医学与重建外科（FPMRS）医疗服务提供者的患者进行的回顾性队列研究。比较了专科医生与初级保健提供者（PCP）的转诊情况。使用描述性统计方法研究了转诊数量、时间及治疗类型。

结果

专科医生转诊184例（78.6%），PCP转诊50例（21.4%）。在转诊至FPMRS之前，51%（26例）的PCP转诊患者尝试了治疗（进行凯格尔运动、放置子宫托及使用抗胆碱能药物），而专科医生转诊患者中这一比例为48%（88例）（P = 0.6）。PCP与专科医生转诊前的治疗时间无显著差异（分别为14个月和16个月，P = 0.88）。然而，转诊前患者的平均患病时间存在显著差异（PCP转诊患者为35个月，专科医生转诊患者为58个月）（P = 0.02）。