全科医生将患者转诊至三级保健专科医生：一项定性研究。
General practitioners referring patients to specialists in tertiary healthcare: a qualitative study.
机构信息
Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, 1011, Lausanne, Switzerland.
Faculty of Social and Political Sciences, University of Lausanne, UNIL, Lausanne, Switzerland.
出版信息
BMC Fam Pract. 2019 Dec 1;20(1):165. doi: 10.1186/s12875-019-1053-1.
BACKGROUND
There is a large and unexplained variation in referral rates to specialists by general practitioners, which calls for investigations regarding general practitioners' perceptions and expectations during the referral process. Our objective was to describe the decision-making process underlying referral of patients to specialists by general practitioners working in a university outpatient primary care center.
METHODS
Two focus groups were conducted among general practitioners (10 residents and 8 chief residents) working in the Center for Primary Care and Public Health (Unisanté) of the University of Lausanne, in Switzerland. Focus group data were analyzed with thematic content analysis. A feedback group of general practitioners validated the results.
RESULTS
Participating general practitioners distinguished two kinds of situations regarding referral: a) "clear-cut situations", in which the decision to refer or not seems obvious and b) "complex cases", in which they hesitate to refer or not. Regarding the "complex cases", they reported various types of concerns: a) about the treatment, b) about the patient and the doctor-patient relationship and c) about themselves. General practitioners evoked numerous reasons for referring, including non-medical factors such as influencing patients' emotions, earning specialists' esteem or sharing responsibility. They also explained that they seek validation by colleagues and postpone referral so as to relieve some of the decision-related distress.
CONCLUSIONS
General practitioners' referral of patients to specialists cannot be explained in biomedical terms only. It seems necessary to take into account the fact that referral is a sensitive topic for general practitioners, involving emotionally charged interactions and relationships with patients, colleagues, specialists and supervisors. The decision to refer or not is influenced by multiple contextual, personal and clinical factors that dynamically interact and shape the decision-making process.
背景
全科医生向专科医生转诊的比率存在很大且无法解释的差异，这需要调查全科医生在转诊过程中的看法和期望。我们的目的是描述在瑞士洛桑大学Santé 大学门诊初级保健中心工作的全科医生向专科医生转诊患者的决策过程。
方法
在瑞士洛桑大学Santé 大学初级保健和公共卫生中心（Unisanté）工作的全科医生（10 名住院医师和 8 名首席住院医师）中进行了两次焦点小组讨论。使用主题内容分析对焦点小组数据进行分析。一个由全科医生组成的反馈小组验证了结果。
结果
参与的全科医生将转诊情况分为两类：a）“明确的情况”，在这种情况下，是否转诊的决定似乎很明显；b）“复杂情况”，在这种情况下，他们犹豫不决。对于“复杂情况”，他们报告了各种类型的担忧：a）关于治疗，b）关于患者和医患关系，c）关于自己。全科医生提出了许多转诊的原因，包括非医学因素，如影响患者的情绪、赢得专家的尊重或分担责任。他们还解释说，他们寻求同事的认可，并推迟转诊，以减轻一些与决策相关的困扰。
结论
全科医生向专科医生转诊患者不能仅用生物医学术语来解释。似乎有必要考虑到这样一个事实，即转诊对全科医生来说是一个敏感的话题，涉及到充满情感的互动以及与患者、同事、专家和主管的关系。是否转诊的决定受到多种上下文、个人和临床因素的影响，这些因素相互作用并塑造决策过程。
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