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基层医疗医生改善眩晕和头晕患者护理的需求及支持工具:一项全国性调查。

Needs and supporting tools for primary care physicians to improve care of patients with vertigo and dizziness: a national survey.

作者信息

Mantokoudis Georgios, Zwergal Andreas, Heg Dierik, Kerkeni Hassen, Diener Suzie, Kalla Roger, Korda Athanasia, Candreia Claudia, Welge-Lüssen Antje, Tarnutzer Alexander Andrea

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, Bern University Hospital, University of Bern, Bern, Switzerland.

German Center for Vertigo and Balance Disorders (DSGZ), LMU University Hospital, Munich, Germany.

出版信息

Front Neurol. 2023 Aug 29;14:1254105. doi: 10.3389/fneur.2023.1254105. eCollection 2023.

Abstract

BACKGROUND

The diagnostic workup and treatment decisions for vertigo or dizziness in primary care can be challenging due to the broad range of possible causes and limited time and expertise of physicians. This can lead to delays in treatment and unnecessary tests. We aimed to identify the unmet needs of primary care physicians (PCPs) and strategies to improve care for dizzy patients.

MATERIALS AND METHODS

An online survey was conducted among board-certified PCPs in Switzerland to explore needs in caring for dizzy patients and potential educational approaches.

RESULTS

Based on responses from 152 participating PCPs, satisfaction and confidence were higher in diagnosing (82%) and treating (76%) acute dizziness compared to episodic/chronic cases (63 and 59%, respectively). Younger PCPs had lower diagnostic yield and confidence. Areas for improvement in specialist interactions included communication between physicians (23%/36%; always/often true), shorter waiting times for consultations (19%/40%), more detailed feedback (36%/35%), and consistent patient back referrals (31%/30%). PCPs expressed interest in hands-on courses, workshops, practical guidelines, web-based algorithms, and digital tools such as printed dizzy diaries and apps for follow-up.

CONCLUSION

Enhanced dialog between PCPs and specialists is crucial to address the most common unmet needs. Reducing waiting times for referrals and providing clear instructions to specialists for triage are essential. The findings from this survey will guide the development of tools to improve the diagnosis and treatment of dizzy patients. Younger PCPs, who face higher diagnostic uncertainty, should be prioritized for educational approaches such as hands-on courses, workshops, and practical recommendations.

摘要

背景

由于可能的病因范围广泛,且基层医疗医生的时间和专业知识有限,因此基层医疗中眩晕或头晕的诊断检查和治疗决策可能具有挑战性。这可能导致治疗延误和不必要的检查。我们旨在确定基层医疗医生(PCP)未满足的需求以及改善头晕患者护理的策略。

材料与方法

对瑞士获得委员会认证的基层医疗医生进行了一项在线调查,以探索照顾头晕患者的需求和潜在的教育方法。

结果

根据152名参与调查的基层医疗医生的回复,与发作性/慢性病例(分别为63%和59%)相比,对急性头晕的诊断(82%)和治疗(76%)的满意度和信心更高。年轻的基层医疗医生的诊断率和信心较低。在与专科医生的互动方面需要改进的领域包括医生之间的沟通(23%/36%;总是/经常如此)、会诊等待时间更短(19%/40%)、更详细的反馈(36%/35%)以及一致的患者转回转诊(31%/30%)。基层医疗医生对手工操作课程、研讨会、实用指南、基于网络的算法以及数字工具(如印刷的头晕日记和随访应用程序)表示感兴趣。

结论

加强基层医疗医生与专科医生之间的对话对于满足最常见的未满足需求至关重要。减少转诊等待时间并向专科医生提供明确的分诊指示至关重要。本次调查的结果将指导开发改善头晕患者诊断和治疗的工具。面临更高诊断不确定性的年轻基层医疗医生应优先接受手工操作课程、研讨会和实用建议等教育方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5a90/10495563/9ad65095593b/fneur-14-1254105-g001.jpg

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