Abdel Kader H Z, Shehata A I, Guirguis W W, Saleh H S, Schacke G
High Institute of Public Health, Alex. University.
J Egypt Public Health Assoc. 1994;69(1-2):89-113.
The present study was designed to investigate the reasons for which patients are referred by G.Ps to G.M. specialists, and to assess the extent to which referred cases need specialist care. The study sample included specialists of general medicine working at 4 of the H.I.O. polyclinics and all G.Ps who referred cases that were considered as inappropriate referrals by the study specialists, as well as 20% of Patients referred to G.M. specialists by G.Ps. were systematically randomly selected during a period of 10 consecutive days. The results indicated that the rate of inappropriate referral to G.M. specialists was high, the rate of discrepancy between G.P. and specialist diagnoses was generally high, there was a high discrepancy between G.Ps and specialists regarding the reason for inappropriate referral, and there was poor communication from the lower (G.P.) to the higher (specialists) levels in the referral process. Reasons for referral to specialists were not recorded by G.Ps in 100% of cases. To overcome these problems H.I.O. should place special emphasis on the professional training and continuing education of G.Ps, with special attention to the few common conditions that were responsible for the greater proportion of referral problems. At the same time, H.I.O. should strengthen the technical and administrative control over G.P. referral behavior.
本研究旨在调查全科医生（G.Ps）将患者转诊至普通内科（G.M.）专科医生的原因，并评估转诊病例对专科护理的需求程度。研究样本包括在4家H.I.O.综合诊所工作的普通内科专科医生以及所有被研究专科医生视为不适当转诊病例的转诊全科医生，还有20%由全科医生转诊至普通内科专科医生的患者，这些患者是在连续10天内系统随机选取的。结果表明，转诊至普通内科专科医生的不适当转诊率很高，全科医生和专科医生诊断之间的差异率总体较高，全科医生和专科医生在不适当转诊原因方面存在很大差异，并且在转诊过程中从较低层级（全科医生）到较高层级（专科医生）的沟通不畅。全科医生在100%的病例中都未记录转诊至专科医生的原因。为克服这些问题，H.I.O.应特别重视全科医生的专业培训和继续教育，尤其关注导致较大比例转诊问题的少数常见病症。同时，H.I.O.应加强对全科医生转诊行为的技术和行政控制。
