Manley Kristyn M, Hillard T, Holloway D, Bruce D, Rymer J
Poole Hospital NHS Trust, Poole, UK.
Guy's and St Thomas' NHS Trust, London, UK.
Post Reprod Health. 2021 Mar;27(1):19-29. doi: 10.1177/2053369120947620. Epub 2020 Aug 27.
Requests for management of menopausal symptoms and hormone replacement are increasing in the UK. Referrals to specialist clinics have to be balanced with increasing recommendations within the NHS to improve efficiency and patient care.
Retrospective evaluation of clinic records over two months at a district general (Poole Hospital) and tertiary (Guy's Hospital) menopause service. Data on referral origin, reason for referral, interval from referral to review and outcome were collected and compared between trusts.
To evaluate and compare referrals and outcomes in a tertiary and district general menopause service and provide recommendations for improving efficiency.
Most referrals are from primary care but up to 25% are from other specialties. Half of the appointments are new referrals and 95% of women attend. Of the new referrals, 50% have multiple medical comorbidities, 25% a personal or family history of cancer and 25% treatment resistance; 30% have premature ovarian insufficiency. At Guy's Hospital, 30% are reviewed more than 18 weeks after referral, at Poole Hospital this is 6%. Treatment resistance is reported in half of the women reviewed at follow-up.
Menopause services review a complex patient population and the majority of referred women have more than one co-morbidity; they require time, specialist knowledge of current treatment options and a multidisciplinary approach. The main barrier to service efficiency is capacity, particularly in population dense areas; cognitive behavioural therapy and non-hormonal methods appear under-utilised in primary care, as do alternative methods of follow-up within the clinics such as telephone and patient-initiated appointments.
在英国，对更年期症状管理及激素替代疗法的需求日益增加。向专科诊所的转诊必须与英国国家医疗服务体系（NHS）中旨在提高效率和改善患者护理的日益增多的建议相平衡。
对一家地区综合医院（普尔医院）和一家三级医院（盖伊医院）更年期服务部门两个月的诊所记录进行回顾性评估。收集了转诊来源、转诊原因、从转诊到复查的间隔时间以及结果等数据，并在各信托机构之间进行比较。
评估和比较一家三级医院和一家地区综合医院更年期服务的转诊情况及结果，并为提高效率提供建议。
大多数转诊来自初级医疗保健机构，但高达25%的转诊来自其他专科。一半的预约是新转诊患者，95%的女性会前来就诊。在新转诊患者中，50%患有多种合并症，25%有个人或家族癌症病史，25%存在治疗抵抗；30%患有卵巢早衰。在盖伊医院，30%的患者在转诊后18周以上才得到复查，在普尔医院这一比例为6%。在随访复查的女性中，有一半报告存在治疗抵抗。
更年期服务部门诊治的患者群体情况复杂，大多数转诊女性患有不止一种合并症；她们需要时间、对当前治疗选择的专业知识以及多学科方法。服务效率的主要障碍是能力问题，尤其是在人口密集地区；认知行为疗法和非激素方法在初级医疗保健中似乎未得到充分利用，诊所内的其他随访方式，如电话随访和患者主动预约，也是如此。
