转诊至二级脊柱中心的患者的转诊情况、症状及治疗——我们如何提供帮助？
Referrals, Symptoms and Treatment of Patients Referred to a Secondary Spine Centre-How Can We Help?
作者信息
Droeghaag Ruud, Nabben Daphne, Smeets Anouk, van Hemert Wouter, van Orshoven Narender, van Santbrink Henk, Most Jasper, Curfs Inez
机构信息
Department of Orthopaedic Surgery, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.
CAPHRI School for Public Health and Primary Care, Maastricht University, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
出版信息
J Clin Med. 2023 Jun 4;12(11):3840. doi: 10.3390/jcm12113840.
INTRODUCTION
Spinal disorders are amongst the conditions with the highest burden of disease. To limit the increase of healthcare-related costs in the ageing population, the selection of different types of care for patients with spinal disorders should be optimized. The first step is to investigate the characteristics of these patients and the relationship with treatment.
RESEARCH QUESTION
The primary aim of this study was to provide insights in the characteristics, symptoms, diagnosis and treatment of patients referred to a specialized spinal health care centre. The secondary aim was to perform an in-depth analysis of resource utilization for a representative subgroup of patients.
METHODS
This study describes the characteristics of 4855 patients referred to a secondary spine centre. Moreover, an extensive analysis of a representative subgroup of patients (~20%) is performed.
RESULTS
The mean age was 58.1, 56% of patients were female, and the mean BMI was 28. In addition, 28% of patients used opioids. Mean self-reported health status was 53.3 (EuroQol 5D Visual Analogue Scale), and pain ranged from 5.8 to 6.7 (Visual Analogue Scale neck/back/arm/leg). Additional imaging was received by 67.7% of patients. Surgical treatment was indicated for 4.9% of patients. The majority (83%) of non-surgically treated patients received out-of-hospital treatment; 25% of patients received no additional imaging or in-hospital treatment.
CONCLUSION
The vast majority of patients received non-surgical treatments. We observed that ~10% of patients did not receive in-hospital imaging or treatment and had acceptable or good questionnaire scores at the time of referral. These findings suggest that there is potential for improvement in efficacy of referral, diagnosis, and treatment. Future studies should aim to develop an evidence base for improved patient selection for clinical pathways. The efficacy of chosen treatments requires investigation of large cohorts.
引言
脊柱疾病是疾病负担最高的病症之一。为限制老年人口中与医疗保健相关的成本增加，应优化针对脊柱疾病患者的不同类型护理的选择。第一步是调查这些患者的特征以及与治疗的关系。
研究问题
本研究的主要目的是深入了解转诊至专业脊柱保健中心的患者的特征、症状、诊断和治疗情况。次要目的是对具有代表性的患者亚组的资源利用情况进行深入分析。
方法
本研究描述了4855名转诊至二级脊柱中心的患者的特征。此外，对一个具有代表性的患者亚组（约20%）进行了广泛分析。
结果
平均年龄为58.1岁，56%的患者为女性，平均体重指数为28。此外，28%的患者使用阿片类药物。自我报告的平均健康状况为53.3（欧洲五维健康量表视觉模拟量表），疼痛程度在5.8至6.7之间（颈部/背部/手臂/腿部视觉模拟量表）。67.7%的患者接受了额外的影像学检查。4.9%的患者需要手术治疗。大多数（83%）非手术治疗的患者接受了院外治疗；25%的患者未接受额外的影像学检查或住院治疗。
结论
绝大多数患者接受了非手术治疗。我们观察到，约10%的患者未接受住院影像学检查或治疗，在转诊时问卷得分可接受或良好。这些发现表明，在转诊、诊断和治疗的有效性方面有改进的潜力。未来的研究应旨在为改进临床路径的患者选择建立证据基础。所选治疗方法的有效性需要对大量队列进行研究。
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