Benninger M S, King F, Nichols R D
Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, MI USA.
Otolaryngol Head Neck Surg. 1995 Oct;113(4):446-52. doi: 10.1016/S0194-59989570083-8.
A prospective evaluation of the effectiveness of otolaryngology evaluation, treatment, and referral guidelines developed collaboratively by otolaryngologists and primary care physicians on referrals and access to otolaryngology. Comparisons of appropriate to unnecessary referrals, the percentage of patients referred with disorders addressed to those without disorders addressed in the guidelines, access to otolaryngology, and questionnaire evaluations of primary care physician and patient satisfaction were measured before and after guideline implementation.
A significant decrease in appropriate to unnecessary referrals was seen, from 55% before to 12% after guidelines. The percentage of patients seen within 1 month of scheduling improved from 39% to 59%. Guideline-addressed disorders decreased from 63% to 40%. The need for patients to see another physician for the referred symptom while waiting to see an otolaryngologist decreased from 31% to 3%. Patient satisfaction with wait times improved. Eighty-six percent of the primary care physicians used the guidelines, and 85% wanted to expand the guidelines to other specialty areas.
Management and referral guidelines are effective in improving patient access and the ratio of appropriate to unnecessary referrals. Such guidelines are well accepted and used by primary care practitioners in this setting.
对耳鼻喉科医生和初级保健医生合作制定的耳鼻喉科评估、治疗及转诊指南在转诊和耳鼻喉科就诊机会方面的有效性进行前瞻性评估。在指南实施前后，对适当转诊与不必要转诊的情况、转诊患者中指南所涵盖疾病患者与未涵盖疾病患者的比例、耳鼻喉科就诊机会以及初级保健医生和患者满意度的问卷调查评估进行比较。
适当转诊与不必要转诊的比例显著下降，从指南实施前的55%降至实施后的12%。预约后1个月内就诊的患者比例从39%提高到59%。指南所涵盖疾病的患者比例从63%降至40%。患者在等待看耳鼻喉科医生期间因转诊症状而需看其他医生的需求从31%降至3%。患者对等待时间的满意度有所提高。86%的初级保健医生使用了该指南，85%的医生希望将该指南扩展到其他专科领域。
管理和转诊指南在改善患者就诊机会以及适当转诊与不必要转诊的比例方面是有效的。在这种情况下，此类指南得到了初级保健从业者的广泛接受和使用。
