Alon Z, Vinker S, Nakar S, Abu-Amar H, Sadovsky G, Hyam E
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Isr J Med Sci. 1997 Nov;33(11):744-8.
Direct self-referrals to a consultant, especially on an urgent basis, has not been widely explored before. The health insurance system in Israel permits elective direct self-referrals to various specialists, but the range and reasons of urgent self-referrals has not yet been evaluated. Our aim was to evaluate urgent self-referrals to ambulatory consultants and to see to what extent a qualified family physician can triage and treat those patients. The setting was an urban ambulatory multi-disciplinary consultation center in the city of Ashdod in central Israel, serving a population of approximately 150,000. Over a three-month period, all patients who made urgent self-referrals for an ambulatory consultant in Ophthalmology, Ear, Nose and Throat (ENT) and Dermatology were triaged by an on-duty qualified family physician. The physician was instructed to take care of the patient in one of three ways: 1) immediate referral to a specialist; 2) begin treatment and schedule the patient for a specialist consultation; 3) administration of definitive treatment. Eight hundred and ninety-eight patients aged 46 +/- 22 years were treated by the triaging family physician. Forty-six percent had ophthalmological symptoms, 26% had dermatological symptoms and 20% had ENT-related symptoms. A symptom duration of less than 24 hours was reported by 36% of the patients. Eye problems were more commonly of short duration (p < 0.001). Sixty percent of the patients were given a definitive treatment, another 19% were given immediate treatment and scheduled for elective consultation with a specialist and 21% were referred for an immediate specialist consultation. Of the immediate consultations, 73% were ophthalmological and 27% came from a range of other complaints (p < 0.001). Our conclusion was that a family physician can treat most of the urgent self-referrals to ambulatory consultations in the three domains that were evaluated. A triage system is particularly suitable for urgent self-referrals to ENT as well as dermatological problems.
直接自我转诊给专科医生，尤其是紧急情况下的转诊，此前尚未得到广泛研究。以色列的医疗保险系统允许患者自行选择直接转诊至各类专科医生，但紧急自我转诊的范围和原因尚未得到评估。我们的目的是评估紧急自我转诊至门诊专科医生的情况，并了解合格的家庭医生对这些患者进行分诊和治疗的程度。研究地点是以色列中部阿什杜德市的一家城市门诊多学科咨询中心，服务人口约15万。在三个月的时间里，所有因眼科、耳鼻喉科（ENT）和皮肤科而紧急自我转诊至门诊专科医生的患者均由一名值班的合格家庭医生进行分诊。该医生被指示以三种方式之一照顾患者：1）立即转诊给专科医生；2）开始治疗并为患者安排专科会诊；3）进行确定性治疗。分诊家庭医生共治疗了898名年龄为46±22岁的患者。46%的患者有眼科症状，26%有皮肤科症状，20%有耳鼻喉科相关症状。36%的患者报告症状持续时间少于24小时。眼部问题的持续时间通常较短（p<0.001）。60%的患者接受了确定性治疗，另有19%的患者接受了立即治疗并被安排择期与专科医生会诊，21%的患者被立即转诊给专科医生。在立即会诊中，73%是眼科会诊，27%来自一系列其他病症（p<0.001）。我们的结论是，家庭医生可以治疗在评估的三个领域中大多数紧急自我转诊至门诊会诊的患者。分诊系统特别适用于紧急自我转诊至耳鼻喉科以及皮肤科问题。
