Research Associate | Centre for General Medicine and Geriatrics, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
Wien Med Wochenschr. 2021 Oct;171(13-14):301-309. doi: 10.1007/s10354-021-00855-5. Epub 2021 Jun 29.
Elevated liver values are often an incidental finding in outpatient care. A solid working relationship between general practitioners and specialists plays as much of a role in effective diagnostics as do selection and examination of liver values and context as indicators for referral towards more in-depth diagnosis. This article focuses on the status quo as well as potential hurdles and challenges in the relationship between general practitioners and specialists with regard to analysing elevated liver values of uncertain origin. A total of 529 physicians in gastroenterological practices in the German states of Baden-Württemberg, Hesse and Thuringia were invited to take part in an online survey in 2020, of which 313 responded. This contribution focuses on those parts of the survey covering the relationship between general practitioners and specialists. According to the results, 72% of the surveyed gastroenterologists saw working relationships between general practitioners and specialists as beneficial and effective. Even so, a variety of challenges and difficulties in everyday care dominate. Specialists especially criticised preliminary analyses performed by general practitioners as well as time of referral. Apart from that, a wide majority (85%) saw a major role in a structured diagnostic algorithm towards improving early detection and coordination between primary and specialist care. The survey revealed problems in the relationship between general practitioners and specialists. Together with targeted training and further training programmes for general practitioners, a validated diagnostic algorithm for classifying and analysing elevated liver values may be a valuable tool for general practitioners to perform diagnostics and improve the structure within which they work with specialists.
肝酶升高通常是门诊护理中的偶然发现。全科医生和专家之间建立稳固的工作关系，对于有效诊断与选择和检查肝酶以及将其作为转诊以进行更深入诊断的指标一样重要。本文重点介绍了在分析来源不明的肝酶升高方面，全科医生和专家之间的关系的现状、潜在障碍和挑战。2020 年，共有来自德国巴登-符腾堡州、黑森州和图林根州的 529 名胃肠病学医生受邀参加在线调查，其中 313 名医生做出了回应。本研究重点介绍了该调查中涵盖全科医生和专家关系的部分。调查结果显示，72%的受访胃肠病学家认为全科医生和专家之间的工作关系是有益且有效的。即便如此，日常护理中仍存在各种挑战和困难。专家尤其批评了全科医生进行的初步分析以及转诊时间。除此之外，绝大多数（85%）人认为，制定一个结构化的诊断算法对于提高初级保健和专科保健之间的早期检测和协调具有重要作用。调查揭示了全科医生和专家之间关系存在的问题。结合对全科医生的有针对性培训和进一步的培训计划，验证过的肝酶升高分类和分析诊断算法可能是全科医生进行诊断和改善与专家合作结构的宝贵工具。
