Kirby R S, Chisholm G, Chapple C, Hudd C, Swallow M, Shore D
Western General Infirmary, Edinburgh, Scotland.
J R Soc Med. 1995 May;88(5):284P-288P.
Recent community-based population surveys have revealed a much greater prevalence of benign prostatic hyperplasia than previously suspected. From these data it has been projected that there may be more than 2 million men in the UK whose quality of life is to some extent impaired by this disorder. Since there are only 330 fully trained urologists in this country it will not be feasible for every individual presenting with prostatism to be assessed by a specialist. In an attempt to provide a more rational basis from which family practitioners can decide whether or not to refer a patient for a specialist opinion a 'shared care' flow diagram was developed and assumptions contained within field tested by means of a postal questionnaire which was sent to 2020 urologists, family practitioners and other interested clinicians. There was general agreement with most of the precepts set out in the flow diagram, the main exception was a rejection of the suggestion that every patient with prostatism should have a prostate-specific antigen level determined before referral. We conclude that there seems a consensus among respondents that a shared care approach to the management of BPH may both improve the standard of care provided in this area by family practitioners and allow hard pressed urologists to focus greater attention on those patients whose conditions require surgical expertise to resolve.
最近基于社区的人口调查显示，良性前列腺增生的患病率比之前预想的要高得多。根据这些数据推测，在英国可能有超过200万男性的生活质量在某种程度上受到这种疾病的损害。由于该国仅有330名训练有素的泌尿科医生，因此让每位出现前列腺增生症状的患者都由专科医生进行评估是不可行的。为了提供一个更合理的依据，以便家庭医生决定是否将患者转诊以获取专科意见，制定了一个“共享护理”流程图，并通过向2020名泌尿科医生、家庭医生和其他感兴趣的临床医生发送邮政问卷的方式，对该流程图中的假设进行了实地测试。对于流程图中列出的大多数准则，大家普遍表示认同，主要的例外是拒绝接受以下建议：每位前列腺增生患者在转诊前都应检测前列腺特异性抗原水平。我们得出的结论是，受访者之间似乎达成了共识，即采用共享护理方法来管理良性前列腺增生，既可以提高家庭医生在该领域提供的护理标准，又能让忙碌的泌尿科医生将更多注意力集中在那些需要手术专业知识来解决病情的患者身上。
