Van Damme R, Drummond N, Beattie J, Douglas G
Katholieke Universiteit, Nijmegen, Netherlands.
Br J Gen Pract. 1994 Jan;44(378):9-13.
In 1989, a shared or integrated care scheme was developed for hospital outpatients with asthma, using the computerized patient record system of Grampian Health Board, Scotland. Patients with asthma attending hospital clinics were entered into this scheme and were invited to attend their general practitioner instead of an outpatient clinic for review of their asthma. Three-monthly questionnaires covering clinical aspects of asthma were sent to these patients and their general practitioners; the latter then returned them to the specialist. Patients could be recalled to the hospital clinic if either the general practitioner or consultant felt this was necessary and all patients were reviewed after one year by the specialist. The success of integrated care for patients with asthma relies on the cooperation of general practitioners.
The aim of this study was to investigate how this scheme worked in general practice, and general practitioners' perceptions of it, in order to identify factors that enhance or inhibit integrated care for patients with asthma in general practice.
A qualitative survey was carried out with a random, stratified sample of 38 of the 317 general practitioners in the region. Semi-structured interviews were designed to elicit general practitioners' accounts of their operation of integrated care and their attitudes towards the scheme.
General practitioners perceived the scheme to have several advantages: the continuity and quality of care provided was improved; and the transmission of information between general practitioner and specialist was enhanced. Regular general practitioner reviews, instigated by standard letters generated by computer, were favoured as being clearly structured. Concerns were raised about the processing of paperwork, and the possibility that unnecessary reviews might be generated.
Integrated care for asthma patients is an acceptable management option among general practitioners.
1989年，利用苏格兰格兰扁健康委员会的计算机化患者记录系统，为医院哮喘门诊患者制定了一项共享或综合护理计划。在医院诊所就诊的哮喘患者被纳入该计划，并被邀请去看他们的全科医生，而不是去门诊复查哮喘。每三个月会向这些患者及其全科医生发送涵盖哮喘临床方面的问卷；然后后者将问卷返还给专科医生。如果全科医生或顾问认为有必要，患者可以被召回医院诊所，并且所有患者在一年后由专科医生进行复查。哮喘患者综合护理的成功依赖于全科医生的合作。
本研究的目的是调查该计划在全科医疗中的运作方式以及全科医生对它的看法，以便确定在全科医疗中促进或抑制哮喘患者综合护理的因素。
对该地区317名全科医生中的38名进行随机分层抽样，开展了一项定性调查。设计了半结构化访谈，以了解全科医生对他们综合护理操作的描述以及他们对该计划的态度。
全科医生认为该计划有几个优点：所提供护理的连续性和质量得到了改善；全科医生与专科医生之间的信息传递得到了加强。由计算机生成的标准信函引发的定期全科医生复查受到青睐，因为其结构清晰。有人对文书工作的处理以及可能产生不必要复查的情况表示担忧。
对哮喘患者的综合护理是全科医生可接受的管理选择。
