Kim Jong-Ho, Cho Nam Su, Park Jin-Young, Yoo Yon-Sik, Oh Joo Han, Noh Kyu Cheol, Lee Yong-Beom, Lee Ho Min, Bang Jin-Young, Kim Jung Youn, Jeong Hyeon Jang, Lim Tae Kang
Department of Orthopedic Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Department of Orthopedic Surgery, Cheil Orthopedic Hospital, Seoul, Korea.
Clin Shoulder Elb. 2024 Sep;27(3):338-344. doi: 10.5397/cise.2024.00381. Epub 2024 Aug 6.
This study aims to investigate the trend of doctor shopping among patients with rotator cuff tear (RCT) before undergoing surgery and to examine the relevance of these findings to the public.
A survey was conducted of 326 patients from 10 hospitals (male, 176; female, 150) who underwent arthroscopic rotator cuff repair (ARCR) for symptomatic RCT between September 2019 and February 2020. A questionnaire was used to obtain data regarding the type of medical care service, medical institutions visited before surgery, number of treatments received, and cost of treatment.
A total of 326 patients (87%) received treatment at least once at another medical institution before visiting the hospital where the surgery was performed. Patients visited an average of 9.4 health providers or physicians for shoulder pain before visiting the hospital where surgery was performed. Among the 326 patients, 148 (45%) visited more than two medical institutions and spent an average of 641,983 Korean won (KRW; $466, 50,000-5,000,000 KRW) before surgery. Medical expenses before surgery were proportional to the number of medical institutions visited (P=0.002), symptom duration (P=0.002), and initial visual analog scale (VAS) pain score (P=0.007) but were not associated with sex, age, VAS pain score immediately before surgery, or RCT size.
Medical expense before ARCR was associated with the severity of preoperative pain and duration of symptoms. After onset of shoulder symptoms, patients should visit as soon as possible a hospital that has surgeons who specialize in shoulder repair to prevent unnecessary medical expense and proper treatment. Level of evidence: IV.
本研究旨在调查肩袖撕裂（RCT）患者在手术前的“择医行为”趋势，并探讨这些发现与公众的相关性。
对2019年9月至2020年2月期间在10家医院接受关节镜下肩袖修复术（ARCR）治疗有症状RCT的326例患者（男性176例，女性150例）进行了调查。采用问卷调查的方式获取有关医疗服务类型、手术前就诊的医疗机构、接受治疗的次数以及治疗费用的数据。
在前往进行手术的医院就诊之前，共有326例患者（87%）至少在另一家医疗机构接受过一次治疗。患者在前往进行手术的医院就诊之前，平均为肩部疼痛咨询过9.4名医疗服务提供者或医生。在这326例患者中，148例（45%）就诊过两家以上医疗机构，术前平均花费641,983韩元（466美元，50,000 - 5,000,000韩元）。术前医疗费用与就诊医疗机构的数量（P = 0.002）、症状持续时间（P = 0.002）和初始视觉模拟量表（VAS）疼痛评分（P = 0.007）成正比，但与性别、年龄、手术前即刻的VAS疼痛评分或RCT大小无关。
ARCR术前医疗费用与术前疼痛的严重程度和症状持续时间相关。肩部症状出现后，患者应尽快前往有擅长肩部修复手术医生的医院就诊，以避免不必要的医疗费用并获得恰当治疗。证据级别：IV级。
