Borkan J, Neher J O, Anson O, Smoker B
Department of Family Medicine, Faculty of the Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
J Fam Pract. 1994 Dec;39(6):545-50.
The purpose of this study was to examine how allopathic physicians participate in the decision to refer patients for alternative therapies.
A pretested, self-administered, structured questionnaire was distributed simultaneously to all area physicians at community locations in Washington State, New Mexico, and southern Israel. The primary outcome measures were monthly and yearly rates of referral to alternative therapies.
More than 60% of all physicians made referrals to alternative providers at least once in the preceding year and 38% in the preceding month. Referrals were generally based on patient requests, synergy between the alternative therapy and the patients' cultural beliefs, failure of conventional treatment, and the belief that patients have "nonorganic" or "psychological" disease. There was no relationship between the rate of referral and the referring physician's level of knowledge about, beliefs about the effectiveness of, or familiarity with alternative therapies.
Primary care physicians are more likely than other medical specialists to be knowledgeable about, personally subscribe to, and refer patients for alternative therapies. Physicians who use alternative techniques for themselves and their families or who adopt complementary therapies into their practices have higher rates of referrals. Referral rates and patterns were similar between sites despite considerable cross-cultural and health system differences. Given the high rate of referral and the absence of an apparent internal logic for such recommendations, guidelines and physician education may be advisable.
本研究的目的是探讨全科医生如何参与决定将患者转介接受替代疗法。
一份经过预测试、自行填写的结构化问卷同时分发给华盛顿州、新墨西哥州和以色列南部社区地点的所有地区医生。主要结局指标是转介接受替代疗法的月度和年度比率。
超过60%的医生在前一年至少有一次将患者转介给替代疗法提供者，在前一个月这一比例为38%。转介通常基于患者的请求、替代疗法与患者文化信仰之间的协同作用、传统治疗的失败，以及认为患者患有“非器质性”或“心理”疾病。转介比率与转诊医生对替代疗法的知识水平、对其有效性的信念或熟悉程度之间没有关系。
与其他医学专科医生相比，初级保健医生更有可能了解、个人认同并将患者转介接受替代疗法。为自己和家人使用替代技术或在其医疗实践中采用补充疗法的医生，其转介率更高。尽管存在相当大的跨文化和卫生系统差异，但各地点之间的转介率和模式相似。鉴于转介率较高且此类推荐缺乏明显的内在逻辑，制定指南和开展医生教育可能是可取的。
