Ryynänen O P, Myllykangas M, Kinnunen J, Takala J
Department of Community Health, University of Kuopio, Finland.
Fam Pract. 1997 Jun;14(3):216-9. doi: 10.1093/fampra/14.3.216.
We aimed to examine the relationship between doctors' willingness to refer elderly patients for elective surgical operations and patients' age, comorbidity, institutionalization, living habits and signs of dementia.
A random selection of 837 medical doctors in Finland (response rate 56%) received a postal questionnaire consisting of 18 vignettes, i.e. imaginary patient cases. Respondents were asked whether they would refer the patient on the vignette for elective surgical operation, treat the patient conservatively, or choose some other alternative. In the vignettes, the age of patients was randomly varied between 65 and 85, at 5-year intervals, to provide eight different questionnaires, and each respondent obtained one of them.
The proportion of doctors willing to refer the patients for surgery was inversely related to the patients' age: in all the vignettes, doctors said they would refer fewer patients in the oldest age groups. Almost all the doctors claimed they would refer healthy, home-dwelling persons aged 65-70 years for operations. In the oldest age groups of patients, the doctors' willingness to refer was highest for cataract operations (69%) and hip prosthesis operations (63%), but only 18% of doctors would refer such patients for coronary by-pass operations. Comorbidity and institutionalization were associated with fewer doctors referring the patients: the proportion of doctors willing to refer these patients was about half that of those willing to refer otherwise healthy and home-dwelling patients. Smoking by patients also decreased the proportions of doctors willing to refer, but moderate signs of dementia in an elderly patient with cataract were associated with only a slight decrease in referring.
Doctors are less willing to refer old patients for elective surgery, but comorbidity, patients' lifestyle and institutionalization have a greater effect on referrals than age.
我们旨在研究医生将老年患者转诊至择期外科手术的意愿与患者年龄、合并症、机构化、生活习惯及痴呆迹象之间的关系。
随机选取芬兰的837名医生（回复率56%），向他们邮寄一份包含18个病例 vignette（即虚构的患者病例）的问卷。询问受访者他们是否会将 vignette 中的患者转诊至择期外科手术、采取保守治疗或选择其他方案。在 vignette 中，患者年龄在65至85岁之间随机变化，间隔为5岁，以提供8种不同的问卷，每位受访者获得其中一份。
愿意将患者转诊至手术的医生比例与患者年龄呈负相关：在所有 vignette 中，医生表示他们会转诊至最年长年龄组的患者较少。几乎所有医生都声称他们会将65 - 70岁健康、居家的人转诊至手术。在最年长的患者年龄组中，医生对白内障手术（69%）和髋关节置换手术（63%）的转诊意愿最高，但只有18%的医生会将此类患者转诊至冠状动脉搭桥手术。合并症和机构化与较少医生转诊患者相关：愿意转诊这些患者的医生比例约为愿意转诊其他健康、居家患者的医生比例的一半。患者吸烟也降低了医生愿意转诊的比例，但白内障老年患者的轻度痴呆迹象仅导致转诊略有减少。
医生不太愿意将老年患者转诊至择期手术，但合并症、患者生活方式和机构化对转诊的影响比年龄更大。
