Ranmuthugala G, McInnes E, Mira M, Rendalls S, Atkin N, Kennedy P
National Centre for Epidemiology and Population Health, New South Wales.
Aust Fam Physician. 1997 Jul;26 Suppl 2:S104-8.
To compare GPs' willingness to participate in a GP pre-discharge project as measured by a survey, with actual participation rates. To identify the characteristics of GPs likely to make a pre-discharge visit to frail, aged inpatients admitted under the care of a geriatrician. METHOD PRE-IMPLEMENTATION GP SURVEY: Survey of a random sample of 100 GPs from the Central Sydney area using a standardised questionnaire. PRE-DISCHARGE VISIT PROJECT: Information on actual participation rates and GPs who declined to make a pre-discharge visit was obtained from an audit of Division of General Practice records. Information on Patient characteristics was obtained from patient interviews and medical records. The survey was conducted at the Balmain Hospital and Concord Repatriation and General Hospitals located within the Central Sydney Area Health Service. The subjects were GPs practising in central Sydney and patients admitted under the care of a geriatrician at Balmain and Concord Hospitals.
Twenty-nine per cent of GPs reported that they were willing to undertake visits without remuneration and 71% reported they were willing to make a pre-discharge visit if remunerated. Fifty-three per cent of GPs actually complied with a request to make a remunerated pre-discharge visit. This was 18% less than the rate determined by the survey. GPs were less likely to make a visit if they were solo practitioners and not members of the Division. Patients who were more dependent, as measured by total Barthel's score, and those from nursing homes were less likely to receive a visit.
GP surveys may overestimate participation rates in Division projects. In reality, it appears difficult for GPs to accommodate pre-discharge visits in a general practice routine and the offered remunerations may not be adequate compensation for time lost when undertaking a pre-discharge visit. Lastly, some GPs may not see a benefit in visiting more dependent patients.
通过一项调查来比较全科医生参与出院前项目的意愿（以调查结果衡量）与实际参与率。确定可能会对在老年病医生照料下的体弱老年住院患者进行出院前探访的全科医生的特征。方法 实施前全科医生调查：使用标准化问卷对悉尼中部地区的100名全科医生进行随机抽样调查。出院前探访项目：通过对全科医学部门记录的审计获取实际参与率信息以及拒绝进行出院前探访的全科医生的信息。通过患者访谈和病历获取患者特征信息。该调查在位于悉尼中部地区卫生服务中心内的巴尔曼医院、康科德遣返总医院进行。研究对象为在悉尼中部执业的全科医生以及在巴尔曼医院和康科德医院接受老年病医生照料的住院患者。
29%的全科医生表示愿意无偿进行探访，71%的全科医生表示如果有报酬愿意进行出院前探访。53%的全科医生实际应要求进行了有报酬的出院前探访。这比调查确定的比例低18%。如果是个体执业者且不是该部门成员，全科医生进行探访的可能性较小。根据巴氏指数总分衡量，依赖性更强的患者以及来自养老院的患者接受探访的可能性较小。
全科医生调查可能高估了部门项目的参与率。实际上，全科医生似乎很难在日常全科医疗工作中安排出院前探访，而且所提供的报酬可能不足以补偿进行出院前探访所损失的时间。最后，一些全科医生可能认为探访依赖性更强的患者没有益处。
