Lowy A, Kohler B, Nicholl J
Medical Care Research Unit, University of Sheffield.
J Public Health Med. 1994 Jun;16(2):134-40. doi: 10.1093/oxfordjournals.pubmed.a042947.
The proportion of attenders at accident and emergency (A&E) departments who present 'inappropriately' with conditions which could be managed in general practice has been estimated at between 6.7 per cent and 64-89 per cent. These estimates have been based on subjective assessments by clinicians, or on an objective classification developed by the Nuffield Provincial Hospitals Trust (NPHT). This study sought to validate this classification, and to develop and validate other objective systems of classifying A&E attenders. Two novel methods were devised, one based on the ICD-9 diagnosis and one primarily on processes of care. All three techniques were validated against the pooled opinions of a sample of general practitioners (GPs). The existing NPHT classification was found to be very unreliable. The new diagnostic method was more specific but had poor sensitivity, whereas the technique based on processes of care agreed remarkably well with the sample of GPs. This method was applied retrospectively to random samples of 8877 adult self-referrals to 16 English A&E departments, and yielded an estimate that 23 per cent could have been treated in general practice. This approach provides a simple and valid retrospective method for identifying patients who were suitable for care in general practice. The method may be used to identify groups of patients who frequently attend inappropriately, to identify areas in which primary care needs are not being effectively met in general practice, and to form a basis for planning and auditing strategies to meet those needs in a more appropriate setting.
因一些在全科医疗中即可处理的病情而“不恰当”前往急诊部门就诊的患者比例，估计在6.7%至64 - 89%之间。这些估计是基于临床医生的主观评估，或者是基于纳菲尔德省立医院信托基金（NPHT）制定的客观分类。本研究旨在验证这种分类，并开发和验证其他对急诊就诊者进行分类的客观系统。设计了两种新方法，一种基于国际疾病分类第九版（ICD - 9）诊断，另一种主要基于护理流程。所有三种技术都对照了一组全科医生（GP）的综合意见进行验证。发现现有的NPHT分类非常不可靠。新的诊断方法更具特异性，但敏感性较差，而基于护理流程的技术与全科医生样本的一致性非常好。该方法被回顾性应用于随机抽取的8877名成年自我转诊至16个英国急诊部门的样本，得出估计有23%的患者本可在全科医疗中得到治疗。这种方法为识别适合在全科医疗中接受治疗的患者提供了一种简单有效的回顾性方法。该方法可用于识别经常不恰当就诊的患者群体，识别在全科医疗中初级保健需求未得到有效满足的领域，并为制定和审核在更合适环境中满足这些需求的策略奠定基础。
