Kahan E, Hart J
Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel.
Fam Pract Res J. 1994 Jun;14(2):167-75.
To determine whether consultants' general impressions of the quality of referrals from family physicians are consistent with their evaluations of the quality of specific referrals.
Data were gathered using two questionnaires, completed separately by the same group of consultants working in a Health Maintenance Organization (HMO). Both questionnaires contained the same items and were designed to cover the following topics: (a) the general impression of the consultants about the quality of referrals received from family physicians; (b) their specific evaluation of all consecutive patient referrals by family physicians over a one-week period. Forty consultants employed in an outpatient regional multidisciplinary clinic of the largest HMO in Israel participated in the study. Of the 3136 referrals received over a one-week period, 1466 fulfilled the inclusion criteria, and 1416 were evaluated (response rate, 97%).
Most of the estimates of the number of unnecessary/inappropriate referrals obtained in the general impression questionnaire were 2 to 5 times higher (p < or = 0.001) than those obtained in the consultants' evaluation questionnaire about specific referrals.
This study suggests that consultants' complaints of unjustified and inappropriate referrals from family physicians must be taken with great reservation, at least within the framework of health systems that do not encourage physicians to produce a large number of services.
确定会诊医生对家庭医生转诊质量的总体印象是否与其对特定转诊质量的评估一致。
使用两份问卷收集数据，由在健康维护组织（HMO）工作的同一组会诊医生分别填写。两份问卷包含相同的项目，旨在涵盖以下主题：（a）会诊医生对从家庭医生处收到的转诊质量的总体印象；（b）他们对家庭医生在一周内连续转诊的所有患者的具体评估。以色列最大的HMO的门诊区域多学科诊所的40名会诊医生参与了该研究。在一周内收到的3136份转诊中，1466份符合纳入标准，1416份得到评估（回复率为97%）。
在总体印象问卷中获得的不必要/不适当转诊数量的大多数估计值比会诊医生对特定转诊的评估问卷中获得的估计值高2至5倍（p≤0.001）。
本研究表明，会诊医生对家庭医生不合理和不适当转诊的抱怨必须持很大的保留态度，至少在不鼓励医生提供大量服务的卫生系统框架内如此。
