Bourguet C, Gilchrist V, McCord G
Division of Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown 44272-0095, USA.
J Fam Pract. 1998 Jan;46(1):47-53.
Consultation and referral are essential components of the practice of primary care. Despite this, little is known about the factors that contribute to the success of a referral. We examined the short-term outcomes of communication between family physicians and consultants during the referral process.
The study setting was six family practice centers in northeastern Ohio. All eligible physicians at each center participated in data collection by means of a card study. Data was recorded on any patient who received a referral to a physician or nonphysician provider during the month of July 1994. One year later, referrals were followed up by physician questionnaire.
Three hundred nine of 5172 total patients were referred (5.97 referrals per 100 office visits). At follow-up, the family physicians reported that 63% of patients had visited the consultant, 14% had not, and the physician had no knowledge of the actions taken by the other 23%. The referring physician received feedback from the consultant regarding 55% of the patients referred. Receipt of feedback was strongly related to communication by the family physician to the consultant at the time of referral. Physicians who received feedback were the most satisfied with communication from the consultant and the care their patient had received.
Primary care physicians can influence the likelihood of receiving feedback from a consultant by initiating communication with the consultant. A referral wherein the physicians involved do not communicate with one another results in physician dissatisfaction. Primary care physicians must practice strategies to improve the referral process.
会诊和转诊是初级保健实践的重要组成部分。尽管如此，对于促成转诊成功的因素却知之甚少。我们研究了转诊过程中家庭医生与会诊医生之间沟通的短期结果。
研究地点为俄亥俄州东北部的六个家庭医疗中心。每个中心所有符合条件的医生通过卡片研究参与数据收集。记录了1994年7月期间转诊给医生或非医生提供者的任何患者的数据。一年后，通过医生问卷调查对转诊情况进行随访。
在总共5172名患者中，有309名被转诊（每100次门诊就诊中有5.97次转诊）。在随访时，家庭医生报告说，63%的患者去看了会诊医生，14%的患者没有去，另有23%的患者，医生不知道其后续情况。转诊医生收到了会诊医生关于55%被转诊患者的反馈。收到反馈与家庭医生在转诊时与会诊医生的沟通密切相关。收到反馈的医生对会诊医生的沟通以及患者所接受的治疗最满意。
初级保健医生可以通过与会诊医生开展沟通来影响收到反馈的可能性。相关医生之间不进行沟通的转诊会导致医生不满。初级保健医生必须采取策略来改善转诊过程。
