Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria 3086, Australia.
Menzies Centre for Health Policy, School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales 2006, Australia.
Public Health. 2021 Apr;193:10-16. doi: 10.1016/j.puhe.2021.01.015. Epub 2021 Mar 4.
The aim of the study was to describe patterns of referral to podiatrists by general practitioners (GPs) in Australia.
This is a continuous cross-sectional study of Australian general practice activity.
We analysed data from the Bettering the Evaluation and Care of Health program, collected from April 2000 to March 2016 inclusive. Data were summarised using descriptive statistics with 95% confidence intervals around point estimates. Multivariate logistic regression was used to identify GP and patient characteristics independently associated with referral.
The data set included 1,568,100 encounters, including 5,912 podiatry referrals. Referrals increased from 7.0 to 39.5 per 1000 population over the evaluation period. In multivariate analyses, female GPs were more likely than male GPs to refer, and GPs aged ≥55 years were less likely to refer. Patients referred to podiatrists were more likely to be aged ≥85 years, be Indigenous, be from an English-speaking background and have previously been seen at the practice. The problem generating the highest number of referrals was diabetes. After the introduction of Medicare funding, referred patients were more likely to be women, be aged >45 years, have a healthcare card, be socio-economically disadvantaged and have previously been seen at the practice.
GP referral to podiatrists in Australia increased markedly after the introduction of Medicare funding and appears to be targeted to those with the greatest need. Further research is required to determine whether this policy has improved outcomes and is cost-effective.
本研究旨在描述澳大利亚全科医生（GP）向足病医生转诊的模式。
这是一项对澳大利亚全科医疗实践活动的连续横断面研究。
我们分析了 Bettering the Evaluation and Care of Health 项目的数据，该数据收集于 2000 年 4 月至 2016 年 3 月期间。使用描述性统计方法对数据进行总结，并对点估计值周围的 95%置信区间进行分析。采用多元逻辑回归分析确定与转诊独立相关的 GP 和患者特征。
数据集包括 1568100 次就诊，其中包括 5912 次足病转诊。在评估期间，转诊率从每千人 7.0 例增加到 39.5 例。在多变量分析中，女性 GP 比男性 GP 更有可能转诊，而年龄≥55 岁的 GP 则不太可能转诊。转诊至足病医生的患者更有可能年龄≥85 岁、为原住民、来自英语国家背景，且之前曾在该诊所就诊。产生转诊数量最多的问题是糖尿病。在引入医疗保险资金后，被转诊的患者更有可能是女性、年龄>45 岁、拥有医疗保健卡、社会经济地位较低，且之前曾在该诊所就诊。
在引入医疗保险资金后，澳大利亚 GP 向足病医生的转诊显著增加，而且似乎针对那些需求最大的患者。需要进一步研究以确定该政策是否改善了结果并具有成本效益。
