Dovey S M, Barton G R, Tilyard M W, Gurr E
Royal New Zealand College of General Practitioners Research Unit, Otago Medical School, Dunedin.
N Z Med J. 1993 Nov 10;106(967):465-7.
The aim of this study was to describe the referral patterns of general practitioners in New Zealand, for a defined list of medical conditions.
A postal questionnaire was sent to a random sample of 200 general practitioners, selected from the Medical Council of New Zealand list. Responses were made on five point scales to indicate general practitioners' views on the appropriateness of referral. For each medical condition, derived from An Educational Guide for General Practice, respondents also indicated favoured agencies for referral. Cluster analysis was used on an SPSSX dataset.
A response rate of 87% (91.5% of eligible contacts) was achieved. The conditions for which referrals were least often made included mild hypertension, rheumatoid arthritis not requiring second line therapy, hypothyroidism, and obesity. Referral was common for rheumatoid arthritis requiring second line therapy, insulin dependent diabetes mellitus, altered bowel habit with rectal bleeding, multiple sclerosis, and postmenopausal bleeding. Seventy seven different referral agencies were indicated by respondents: the most common was the general physician (13% of all agencies indicated).
Although there are a large number of conditions which are routinely managed only in general practice, general practitioners need to be able to refer patients to other health carers, even if only occasionally. There is a high degree of consensus as to the conditions for which referral is usually appropriate. They tend to be conditions requiring well defined investigation, treatment or management procedures which are commonly provided by centralised secondary or tertiary institutions.
本研究旨在描述新西兰全科医生针对一系列特定医疗状况的转诊模式。
向从新西兰医学委员会名单中随机抽取的200名全科医生邮寄问卷调查表。采用五点量表作答，以表明全科医生对转诊适宜性的看法。对于源自《全科医学教育指南》的每种医疗状况，受访者还指出了倾向的转诊机构。对SPSSX数据集进行聚类分析。
回复率达到87%（符合条件联系人的91.5%）。转诊最少的状况包括轻度高血压、无需二线治疗的类风湿性关节炎、甲状腺功能减退和肥胖症。对于需要二线治疗的类风湿性关节炎、胰岛素依赖型糖尿病、伴有直肠出血的排便习惯改变、多发性硬化症和绝经后出血，转诊很常见。受访者指出了77个不同的转诊机构：最常见的是全科医生（占所有机构的13%）。
尽管有大量状况通常仅在全科医疗中处理，但全科医生需要能够将患者转诊给其他医疗服务提供者，即便只是偶尔转诊。对于通常适宜转诊的状况存在高度共识。这些状况往往是需要明确的检查、治疗或管理程序的，而这些程序通常由集中的二级或三级机构提供。
