Department of Urogynaecology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield University, Sheffield, UK.
J Obstet Gynaecol. 2021 Oct;41(7):1087-1091. doi: 10.1080/01443615.2020.1821617. Epub 2020 Nov 25.
This was a retrospective review of a tertiary Paediatric and Adolescent Gynaecology (PAG) referral service catering to the South Yorkshire population in the UK. All patients referred to the PAG clinic from May 2014 to May 2018 were included. Treatments offered in clinic (surgical and pharmacological) were assessed and referral made to alternative services were analysed. Reasons for referral and the number of patients requiring intervention, pharmacological or surgical including a breakdown of the treatments offered were analysed. Forty-four percent (44%) of referrals were for menstrual disorders, with pain (15%) and vulvar problems (13%) being the next common causes. Only 5% of patients needed specialist surgery. Patients attending a PAG clinic are predominantly managed with pharmacological intervention and this could be provided in primary care with referrals limited to complex patients or those who require surgery. By understanding the case load for the PAG clinics, commissioners can better streamline the services.IMPACT STATEMENT PAG services are relatively new and there are no clear pathways of how these should be configured. A better understanding of the case load in PAG clinics will allow configuration of services with better stratification of care to primary secondary and tertiary care providers. The results of this study identify that the vast majority of patients attending PAG services do so with menstrual problems and relatively minor problems that can be addressed by primary care physicians with adequate training. For more rare congenital anomalies, patients are best managed in a specialised centre that can offer a range of different treatments.
这是对英国南约克郡一个三级儿科和青少年妇科（PAG）转诊服务的回顾性研究。纳入了 2014 年 5 月至 2018 年 5 月期间转诊至 PAG 诊所的所有患者。评估了在诊所提供的治疗方法（手术和药物治疗），并对转至其他服务的情况进行了分析。分析了转诊的原因、需要干预的患者数量（药物或手术），并对提供的治疗方法进行了细分。44%的转诊是因为月经失调，其次是疼痛（15%）和外阴问题（13%）。只有 5%的患者需要专科手术。到 PAG 诊所就诊的患者主要接受药物治疗，这可以在初级保健机构中进行，将转诊仅限于复杂患者或需要手术的患者。通过了解 PAG 诊所的病例量，管理者可以更好地优化服务。
PAG 服务相对较新，目前尚不清楚应如何配置这些服务。更好地了解 PAG 诊所的病例量将允许对服务进行配置，更好地对初级、二级和三级医疗保健提供者进行分层护理。这项研究的结果表明，绝大多数到 PAG 就诊的患者都存在月经问题和相对较小的问题，初级保健医生经过充分培训后可以对这些问题进行治疗。对于更罕见的先天性异常，患者最好在专门的中心接受治疗，该中心可以提供多种不同的治疗方法。
