Reeve H, Baxter K, Newton P, Burkey Y, Black M, Roland M
National Primary Care Research and Development Centre, University of Manchester, UK.
Fam Pract. 1997 Feb;14(1):24-8. doi: 10.1093/fampra/14.1.24.
Nearly three-quarters of patients seen in specialist outpatient clinics in England are in follow-up. It has been suggested that the care of many of these patients could be transferred to general practice.
We aimed to estimate the proportion of patients in general practice who are in long-term outpatient follow-up, and to identify GPs' perspectives on the appropriateness and implications of the discharge of their patients to primary care.
Prevalence data were collected by identifying correspondence from outpatient clinics to GPs in four Manchester practices (population 29,000). GPs were asked to assess the suitability for discharge of their patients who were seen in medical outpatient clinics. Semi-structured interviews were carried out with 15 of these GPs, and with 11 GPs who had patients recently discharged from medical clinics.
At least 4.5% of the practice populations were in long-term outpatient follow-up (median duration 25 months). These patients had consulted their GP a median of seven times during the previous year. GPs were willing to take over the care of 48% of patients in medical clinics, and in many cases did not expect that this would lead to an increase in their workload. Some resource needs were identified in general practice, and improvements to the process of discharge were suggested.
The need for continued follow-up in outpatient clinics should be reviewed. Many patients could be discharged without increasing GPs' workload. For more complex cases, additional resources may be needed to provide co-ordinated care within general practice. When patients are discharged, GPs need information quickly and need access to specialist advice for their patients when necessary without long delays.
在英国，近四分之三在专科门诊就诊的患者处于随访阶段。有人建议，其中许多患者的护理工作可以转移到全科医疗中。
我们旨在估计处于长期门诊随访的全科医疗患者比例，并确定全科医生对于将其患者转至初级医疗的适宜性及影响的看法。
通过识别来自四个曼彻斯特医疗机构（人口29000）门诊给全科医生的信函来收集患病率数据。要求全科医生评估其在医疗门诊就诊的患者是否适合出院。对其中15名全科医生以及11名有患者近期从医疗门诊出院的全科医生进行了半结构化访谈。
至少4.5%的医疗机构人群处于长期门诊随访中（中位时长25个月）。这些患者在前一年中平均向其全科医生咨询过7次。全科医生愿意接管48%的医疗门诊患者的护理工作，并且在许多情况下预计这不会导致其工作量增加。确定了全科医疗中的一些资源需求，并提出了改进出院流程的建议。
应重新审视门诊持续随访的必要性。许多患者可以出院而不增加全科医生的工作量。对于更复杂的病例，可能需要额外资源以在全科医疗中提供协调护理。当患者出院时，全科医生需要迅速获得信息，并在必要时能够为其患者获取专科建议而无需长时间等待。
