Olin P, Bolme P, Ewert G, Lagerkvist B, Sterky G, Tengvald K, Zetterström R
Acta Paediatr Scand. 1979 May;68(3):305-13. doi: 10.1111/j.1651-2227.1979.tb05012.x.
Acute otitis media was used as a tracer condition for comparing patient care as regards patient satisfaction, compliance and medical outcome in a district paediatric office, an otolaryngological and a paediatric hospital emergency department. The initial work-up of the 216 patients studied at the three units was in good agreement with predefined standards. However, while the district paediatrician arranged a follow-up for all patients, the hospitals did so only in 10--30% of the visits. Parent satisfaction was significantly higher at the district office when the time spent waiting and the time the patient was with the doctor were kept constant. Urinary penicillin was not detected in 1/17 of district paediatric and in 6/19 of otological patients. Compliance with follow-up was also much higher at the district paediatrician. Medical outcome did not differ between the units. The majority of the parents expressed preference for the type of care given in a neighbourhood service. It is suggested that the criteria for adequate treatment of acute otitis media adapted for emergency departments may be revised in case easy access is provided to a medical centre offering continuity of care and proper follow-up. Studies of the quality of care have so far not managed to demonstrate a definite and positive relationship between the process of care, patient satisfaction and final medical results.
急性中耳炎被用作一种追踪病症，用以比较地区儿科诊所、耳鼻喉科及儿科医院急诊科在患者满意度、依从性和医疗结果方面的患者护理情况。在这三个机构接受研究的216名患者的初始检查与预先设定的标准高度一致。然而，地区儿科医生会为所有患者安排随访，而医院仅在10%至30%的就诊病例中安排随访。当等待时间和患者与医生相处的时间保持不变时，地区诊所的家长满意度显著更高。地区儿科患者中有1/17、耳鼻喉科患者中有6/19未检测到尿青霉素。地区儿科医生处的随访依从性也高得多。各机构之间的医疗结果并无差异。大多数家长表示更喜欢社区服务提供的护理类型。建议在能够方便地前往提供持续护理和适当随访的医疗中心的情况下，可能需要修订适用于急诊科的急性中耳炎充分治疗标准。迄今为止，护理质量研究尚未成功证明护理过程、患者满意度和最终医疗结果之间存在明确的积极关系。
