van Suijlekom-Smit L W, Bruijnzeels M A, van der Wouden J C, van der Velden J, Visser H K, Dokter H J
Department of Paediatrics, Erasmus University and University Hospital/Sophia Children's Hospital, Rotterdam, The Netherlands.
Br J Gen Pract. 1997 Jan;47(414):19-23.
Insight into referral patterns provides general practitioners (GPs) and specialists with a frame of reference for their own work and enables assessment of the need for secondary care. Only approximate information is available.
To determine how often, to which specialties and for what conditions children in different age groups are referred, as well as how often a condition is referred given the incidence in general practice.
From data of the Dutch National Survey of Morbidity and Interventions in General Practice, 63,753 new referrals (acute and non-acute) were analysed for children (0-14 years) from 103 participating practices (161 GPs) who registered. Practices were divided into four groups. Each group of practices participated for three consecutive months covering a whole year altogether. We calculated referral rates per 1000 children per year and referability rates per 100 episodes, which quantifies the a priori chance of a condition being referred for specialist care.
The referral rate varied by age from 231 for children under 1 year old to 119 for those aged 10-14 years (mean 159). The specialties mainly involved were ENT, paediatrics, surgery, ophthalmology, dermatology and orthopaedics. Referrals in the first year of life were most frequently to paediatricians (123); among older children the referral rate to paediatricians decreased (mean 36). Referrals to ENT specialists were seen particularly in the age groups 1-4 (71) and 5-9 (53). For surgery, the referral rate increased by age from 19 to 34. Differences between boys and girls were small, except for surgery. The highest referral rates were for problems in the International Classification of Primary Care (ICPC) chapters: respiratory (28); musculoskeletal (25); ear (24) and eye (21). Referability rates were, in general, low for conditions referred to paediatrics and dermatology and high for surgery and ophthalmology. The variation in problems presented to each specialty is indicated by the proportion of all referrals constituted by the 10 most frequently referred diagnoses: from 35% for paediatrics to 81% for ENT; for ophthalmology, five diagnoses accounted for 83% of all referrals.
The need for specialist care in childhood is clarified with detailed information for different age categories, specialties involved and variation in morbidity presented to specialists, as well as the proneness of conditions to be referred.
深入了解转诊模式可为全科医生（GP）和专科医生提供其自身工作的参考框架，并有助于评估二级医疗的需求。目前仅有大致信息。
确定不同年龄组儿童转诊的频率、转诊至哪些专科以及因何种病症转诊，以及根据全科医疗中的发病率确定某种病症的转诊频率。
从荷兰全国全科医疗发病率和干预调查的数据中，分析了来自103个参与诊所（161名全科医生）登记的63753例新转诊病例（急性和非急性），这些病例为0至14岁的儿童。诊所被分为四组。每组诊所连续参与三个月，全年共覆盖一年。我们计算了每年每1000名儿童的转诊率以及每100例病例的可转诊率，后者量化了某种病症被转诊至专科治疗的先验概率。
转诊率因年龄而异，1岁以下儿童为231，10至14岁儿童为119（平均159）。主要涉及的专科有耳鼻喉科、儿科、外科、眼科、皮肤科和骨科。1岁以内儿童最常转诊至儿科医生（123）；年龄较大儿童转诊至儿科医生的比率下降（平均36）。耳鼻喉科专家的转诊在1至4岁（71）和5至9岁（53）年龄组尤为常见。对于外科，转诊率随年龄从19增至34。除外科外，男孩和女孩之间的差异较小。国际初级保健分类（ICPC）章节中问题的转诊率最高的是：呼吸系统（28）；肌肉骨骼系统（25）；耳部（२४）和眼部（२१）。一般而言，转诊至儿科和皮肤科的病症的可转诊率较低，而外科和眼科的可转诊率较高。每个专科所呈现问题的差异通过10种最常转诊诊断在所有转诊病例中所占比例来体现：儿科为35%，耳鼻喉科为81%；对于眼科，五种诊断占所有转诊病例的83%。
通过针对不同年龄类别、所涉及专科以及专科所呈现发病率差异的详细信息，以及病症的转诊倾向，明确了儿童期对专科护理的需求。
