Luzzatto G, Bertomoro A, Cella G, Fabris F, Girolami A
Malattie del Sangue Università di Padova, Azienda Ospedaliera di padova e Cattedre di Medicina Interna IV.
Epidemiol Prev. 1996 Oct-Dec;20(4):304-12.
We evaluated retrospectively 357 consecutive inpatients (M = 157; F = 200) 14=93 wars old (mean 60.9 +/- 1.0, SF: M = 59.5 +/- 1.4: F = 61.9 +/- 1.4) treated by a same physician at the 2nd Division of Medicine, Padua University Hospital, from January 1993 to July 1995. Such Division, which is representative of the Internal Medicine of an important Center has a high medical standard, as evaluated on the basis of academical and scientific titles of its staff, but no specific geriatric facilities. Patients had been assigned to the Division and, within it, to a given physician at random. 38.1% of patients were older than 70 (M = 30.0; F = 44.5, p < 0.01). Apart from the previous group, 29.1% of admissions (M = 28.0; F = 30.0) were inappropriate. 4.5% of admissions were terminally-ill cancer patients, already diagnosed and treated at other divisions and not further susceptible of specific therapy. Only 28.3% of patients (M = 38.2; F = 20.5, p < 0.0005) did not fall within any of the previous categories, but 33% of the days of their hospital stay were inappropriate (M = 30; F = 37). The mean hospital stay was 10.2 +/- 0.5 SE days (M = 10.4 +/- 0.6; F = 10.1 +/- 0.6). Considering patients altogether, the mean hospital stay was longer for patients older than 70 than for the others (12 +/- 0.9 vs. 9.3 +/- 0.5 days, p < 0.01) and a significant correlation was observed between age and stay length (r = 0.249, p < 0.0001). The educational level of inpatients was as follows: no education and elementary 65.8%; junior-high 20.7%; high 8.9%; university 4.4% with no difference between sexes, nor as compared to the general population, adjusted for age. It is concluded that a highly qualified division, to which it would appear appropriate applying only for cases not manageable as outpatients or by less qualified institutions, is suboptimally utilized with waste of money and resources. This is due to a deficiency in geriatric and residential facilities as well as in community and domiciliary care, to a noxious culture subordinating internal medicine to specialty branches and to the inadequate use of resources by both physicians and patients, in particular, among them, by females.
我们回顾性评估了1993年1月至1995年7月在帕多瓦大学医院第二内科由同一位医生治疗的357例连续住院患者（男性157例；女性200例），年龄在14至93岁之间（平均60.9±1.0岁，标准差：男性59.5±1.4岁；女性61.9±1.4岁）。该科室代表了一个重要中心的内科，根据其工作人员的学术和科学头衔评估，具有较高的医疗水平，但没有专门的老年设施。患者被随机分配到该科室，并在科室中分配给特定的医生。38.1%的患者年龄超过70岁（男性30.0例；女性44.5例，p<0.01）。除了前一组患者外，29.1%的入院患者（男性28.0例；女性30.0例）入院并不恰当。4.5%的入院患者是晚期癌症患者，已在其他科室确诊并接受治疗，不再适合接受特定治疗。只有28.3%的患者（男性38.2例；女性20.5例，p<0.0005）不属于上述任何一类，但他们住院天数的33%并不恰当（男性30天；女性37天）。平均住院时间为10.2±0.5标准误天（男性10.4±0.6天；女性10.1±0.6天）。总体考虑患者，70岁以上患者的平均住院时间比其他患者长（12±0.9天对9.3±0.5天，p<0.01），并且观察到年龄与住院时间之间存在显著相关性（r=0.249，p<0.0001）。住院患者的教育水平如下：未受过教育和小学水平占65.8%；初中水平占20.7%；高中水平占8.9%；大学水平占4.4%，男女之间以及与按年龄调整后的普通人群相比均无差异。结论是，一个高素质的科室，似乎只适合收治门诊无法处理或资质较低机构无法处理的病例，但目前该科室利用不充分，浪费了资金和资源。这是由于老年和居住设施以及社区和家庭护理不足，存在一种有害的文化，使内科从属于专科分支，以及医生和患者，特别是女性对资源的利用不足。
