在脊柱外科医生对转诊患者进行初步评估时，使用具有扩展角色的全科医生：初步经验和挑战。

Using general practitioners with an extended role in spinal practice for the initial assessment of patients referred to spinal surgeons: preliminary experience and challenges.

机构信息

The International Spine Centre, Norwood, South Australia, Australia.

Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia.

出版信息

Prim Health Care Res Dev. 2023 Jan 26;24:e9. doi: 10.1017/S1463423622000494.

DOI:10.1017/S1463423622000494

PMID:36700455

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9884532/

Abstract

AIM

To describe experience using general practitioners (GPs), with an extended role (GPwER) in spinal medicine, to expedite assessment, triage, and management of patients referred from primary care for specialist spinal surgical opinion.

BACKGROUND

Low back and neck pain are common conditions in primary care. Indiscriminate or inappropriate referral to a spinal surgeon contributes to long waiting times. Previous attempts at triaging patients who really require a surgical opinion have used practice nurses, physiotherapists, clinical algorithms, and interdisciplinary screening clinics.

METHODS

Within the setting of an independent spinal care centre, we have used GPs specially trained in spinal practice to expedite the assessment and triage of new referrals between 2015 and 2021. We reviewed feedback from a Patient Satisfaction Questionnaire and the postgraduate backgrounds, training, practice with regard to triage of new referrals, and experiences of the GPs who were recruited.

FINDINGS

Six GPwER had a mean of 26 years of postgraduate experience before appointment (range 10-44 years). The first four GPwER, appointed between 2015 and 2018, underwent an ad hoc in-house, interdisciplinary training programme and saw 2994 new patients between 2016 and 2020. After GPwER, assessment in only 18.9% (range 12.6 to 22.7%) of these patients was a spinal surgical opinion deemed necessary. Waiting times to see the spinal surgeon remained at 6-8 weeks despite a three-fold annual increase (from 340 to 1058) in new referrals. A Patient Satisfaction Questionnaire revealed high levels of satisfaction with the performances of the GPwER across seven dimensions. A dedicated training programme was designed in 2020, and the last two appointees underwent 20 h of clinical teaching prior to practice. Initial experience using GPwER, here termed 'Spinal Clinicians', suggests they are efficient at screening for patients needing spinal surgical referral. Establishing a recognised training programme, assessment, and certification for these practitioners are the next challenges.

摘要

目的

描述在脊柱医学中使用具有扩展角色的全科医生（GPwER）的经验，以加快从初级保健转诊来接受专家脊柱外科意见的患者的评估、分诊和管理。

背景

下背部和颈部疼痛是初级保健中的常见病症。对确实需要手术意见的患者进行无差别的或不适当的转诊会导致等待时间延长。以前尝试使用执业护士、物理治疗师、临床算法和跨学科筛查诊所对需要手术意见的患者进行分诊。

方法

在一个独立的脊柱护理中心的环境中，我们在 2015 年至 2021 年期间使用专门接受过脊柱实践培训的全科医生来加快新转诊患者的评估和分诊。我们回顾了患者满意度问卷调查的反馈，以及新转诊患者分诊方面的研究生背景、培训、执业经验，以及招聘的全科医生的经验。

结果

六名 GPwER 在任命前平均有 26 年的研究生工作经验（范围为 10-44 年）。前四名 GPwER 于 2015 年至 2018 年期间任命，参加了一个临时的跨学科培训计划，并在 2016 年至 2020 年期间看了 2994 名新患者。在 GPwER 之后，这些患者中只有 18.9%（范围为 12.6%至 22.7%）被认为需要进行脊柱手术意见。尽管新转诊患者的数量每年增加三倍（从 340 人增加到 1058 人），但到脊柱外科医生的就诊时间仍保持在 6-8 周。患者满意度问卷调查显示，患者对 GPwER 在七个方面的表现非常满意。2020 年设计了一个专门的培训计划，最后两名任命者在执业前接受了 20 小时的临床教学。使用 GPwER（此处称为“脊柱临床医生”）的初步经验表明，他们在筛选需要脊柱手术转诊的患者方面效率很高。为这些从业者建立公认的培训计划、评估和认证是下一个挑战。