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[全科医疗中尿路感染的症状。全科医生、微生物学家和泌尿科医生之间诊断标准及治疗的比较]

[Symptoms of urinary tract infections in general practice. A comparison of diagnostic criteria and treatment among general practitioners, microbiologists and urologists].

作者信息

Olesen F, Ostergaard I

机构信息

Aarhus Universitet, Forskningsenheden for Almen Medicin.

出版信息

Ugeskr Laeger. 1996 Dec 30;159(1):45-8.

PMID:9012074
Abstract

General practitioners' criteria for good clinical practice vary, and it is unknown whether systematic education by specialists could be expected to reduce variation. The aim of this was to describe general practitioners', microbiologists' and urologists' criteria for diagnosis, treatment, and follow-up of women with symptoms of urinary tract infection. Based on these examples, advantages and disadvantages of using specialists as consultants in GPs' peer-group-based CME (continued medical education) are discussed. Three short case vignettes were presented in a questionnaire to GPs, microbiologists and urologists with prechosen choice of diagnostic, treatment, and follow-up strategy. A total of 154 (77%) GPs, 45 (51%) microbiologists, and 54 (61%) urologists answered the questionnaires. There was considerable variation in proposed strategy both within each specialty and between the specialties. Microbiologists, and to some extent urologists, would more often than the GPs treat a 30-year-old woman via telephone advice and prescription, while they more often tended to ask a 10- and 60-year-old woman to come to the clinic for examination. The GPs, more than the other doctor groups, would ask the patients to return for follow-up. Continuous medical education of GPs based on small-group peer discussions and with specialists as consultants in the groups cannot be expected to lead to less variation in choice of medical strategy.

摘要

全科医生对良好临床实践的标准各不相同,目前尚不清楚专科医生的系统教育是否有望减少这种差异。本研究的目的是描述全科医生、微生物学家和泌尿科医生对有尿路感染症状女性的诊断、治疗及随访标准。基于这些实例,讨论了在全科医生基于同行小组的继续医学教育中聘请专科医生作为顾问的利弊。通过问卷向全科医生、微生物学家和泌尿科医生呈现了三个简短的病例 vignettes,并预先设定了诊断、治疗及随访策略的选择。共有154名(77%)全科医生、45名(51%)微生物学家和54名(61%)泌尿科医生回答了问卷。各专业内部以及不同专业之间在建议策略上存在相当大的差异。微生物学家以及在一定程度上泌尿科医生,比全科医生更常通过电话咨询和开处方来治疗一名30岁女性,而他们更倾向于让一名10岁和60岁女性前来诊所进行检查。与其他医生群体相比,全科医生更会要求患者回来进行随访。基于小组同行讨论并以专科医生作为小组顾问对全科医生进行继续医学教育,预计不会使医疗策略选择上的差异减少。

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