Vierhout W P, Knottnerus J A, van OOij A, Crebolder H F, Pop P, Wesselingh-Megens A M, Beusmans G H
University of Limburg, Maastricht, Netherlands.
Lancet. 1995 Oct 14;346(8981):990-4. doi: 10.1016/s0140-6736(95)91686-5.
Joint consultation sessions between general practitioners (GPs) and specialists to examine patients for whom decisions about referral are difficult are thought to be helpful, but their effects have not been evaluated. In a randomised, controlled trial we studied the effects of joint sessions of GPs and orthopaedic surgeons on referral and intervention rates. During 1.5 years, 12 GPs (in groups of three) held monthly joint consultation sessions with four participating orthopaedic surgeons: patients were seen by one orthopaedic surgeon in the presence of three GPs. Patients were included in the trial if the GP was uncertain about the diagnostic or therapeutic management and if referral was considered; and excluded if referral was urgently necessary or if there was some other clear indication for referral. By a randomised consent design, patients were assigned to joint consultation sessions (n = 144) or a usual-care control group (n = 128). A year later the patients were examined by an independent orthopaedic surgeon. There were significantly fewer referrals (51/144 [35%] vs 87/128 [68%], p < 0.01) and diagnostic actions in the intervention group than in the control group, without negative effects on health or functional status. More patients in the intervention group were symptom-free at 1 year (35% vs 24%, p < 0.05). Joint consultation sessions of GPs and orthopaedic surgeons within the framework of general practice resulted in more efficient care, with better targeted examination, treatment, and referrals.
全科医生（GP）与专科医生之间进行联合会诊，以检查那些转诊决策困难的患者，人们认为这种会诊是有帮助的，但尚未对其效果进行评估。在一项随机对照试验中，我们研究了全科医生与骨科医生联合会诊对转诊率和干预率的影响。在1.5年的时间里，12名全科医生（每三人一组）每月与四名参与的骨科医生举行联合会诊：患者由一名骨科医生在三名全科医生在场的情况下进行诊治。如果全科医生对诊断或治疗管理不确定且考虑转诊，则将患者纳入试验；如果急需转诊或有其他明确的转诊指征，则将患者排除。通过随机同意设计，将患者分配到联合会诊组（n = 144）或常规护理对照组（n = 128）。一年后，由一名独立的骨科医生对患者进行检查。与对照组相比，干预组的转诊（51/144 [35%] 对87/128 [68%]，p < 0.01）和诊断行为明显减少，且对健康或功能状态没有负面影响。干预组中更多患者在1年后无症状（35% 对24%，p < 0.05）。在全科医疗框架内，全科医生与骨科医生的联合会诊带来了更高效的医疗服务，检查、治疗和转诊更具针对性。
