Novak Kerri L, Halasz Jennifer, Andrews Christopher, Johnston Colleen, Schoombee Willem, Tanyingoh Divine, Kaplan Gilaad G, van Zanten Sander Veldhuyzen, Swain Mark
University of Calgary, Alberta, Canada.
Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
J Can Assoc Gastroenterol. 2020 Apr;3(2):59-66. doi: 10.1093/jcag/gwy061. Epub 2018 Oct 24.
Gastroesophageal reflux disease (GERD), dyspepsia and irritable bowel syndrome (IBS) are common gastrointestinal disorders accounting for a significant demand for specialty care. The aim of this study was to evaluate safety, access and outcomes of patients assessed by a nurse-led, shared medical appointment.
This prospective observational study utilized a sample of 770 patients referred to a gastroenterology Central Access and Triage for routine GERD, dyspepsia or IBS from 2011 to 2014. Patient demographics, clinical indication, frequency and outcomes of endoscopy, quality of life, wait times and long-term outcomes (>2 years) were compared between 411 patients assigned to a nurse-led, shared medical appointment and 359 patients assigned to clinic for a gastroenterology physician consultation.
The nurse-led, shared medical appointment pathway compared with usual care pathway had shorter median wait times (12.6 weeks versus 137.1 weeks, P < 0.0001), fewer endoscopic exams (50.9% versus 76.3%, P < 0.0001), less gastroenterology re-referrals (4.6% versus 15.6%, P < 0.0001), and reduced visits to the emergency department (6.1% versus 12.0%, P = 0.004). After two years of follow-up, outcomes were no different between the pathways.
Patients with GERD, IBS or dyspepsia who attend the nurse-led, shared medical appointment have improved access to care and reduced resource utilization without increased risk of significant gastrointestinal outcomes after two years of follow-up.
胃食管反流病（GERD）、消化不良和肠易激综合征（IBS）是常见的胃肠道疾病，对专科护理有很大需求。本研究的目的是评估由护士主导的共享医疗预约评估患者的安全性、可及性和结局。
这项前瞻性观察性研究使用了2011年至2014年间转诊至胃肠病学中央接入和分诊处进行常规GERD、消化不良或IBS评估的770例患者样本。比较了分配到护士主导的共享医疗预约的411例患者和分配到胃肠病学医生会诊门诊的359例患者的人口统计学特征、临床指征、内镜检查频率和结局、生活质量、等待时间和长期结局（>2年）。
与常规护理途径相比，护士主导的共享医疗预约途径的中位等待时间更短（12.6周对137.1周，P<0.0001），内镜检查更少（50.9%对76.3%，P<0.0001），胃肠病学再次转诊更少（4.6%对15.6%，P<0.0001），急诊科就诊次数减少（6.1%对12.0%，P=0.004）。经过两年的随访，两种途径的结局没有差异。
参加护士主导的共享医疗预约的GERD、IBS或消化不良患者在两年随访后获得了更好的医疗服务可及性，资源利用减少，且重大胃肠道结局风险未增加。
