Maheswaran R, Davis S
Department of Epidemiology and Public Health, Imperial College School of Medicine, St Mary's Hospital, London, UK.
Clin Rehabil. 1998 Jun;12(3):265-71. doi: 10.1191/026921598670048508.
To examine referral patterns and characteristics of patients assessed by a community stroke rehabilitation service utilizing an open referral system.
Descriptive study.
Two boroughs in a health district in South London, England.
Two hundred and seventy-six patients with stroke assessed by the service in its first 18 months of operation.
Patients were referred from a variety of sources including hospitals (38%), general practitioners (18%), district nurses (10%), social services (9%), self-referrals (8%), community physiotherapists (7%) and family or carers (2%). Referrals from hospital were younger (33% aged under 65 years) while referrals from community health and social services were older (44% aged 75-84 years) (chi(2) = 23, df = 9, p < 0.01). Fifty per cent of patients who had self-referred or had been referred by families or carers had longstanding stroke (> 1 year), 46% of patients from general practitioners had acute stroke (< 4 weeks) and 37% of hospital patients were seen between one and three months post stroke (chi(2) = 50.4, df = 12, p < 0.001). There was a marginally significant difference in the prevalence of incontinence and no significant differences in limb weakness, visual impairment and speech impairment. There were no significant changes in sources of referral between the first and second nine months of the service. There was a significant increase in the percentage of patients with recent stroke seen in the second nine months (chi(2) = 22.8, df = 5, p < 0.001). In this period, 36% of patients assessed were seen within four weeks of their stroke compared with 15% in the first nine months. Of patients with stroke, 8.7% were considered to have been inappropriate referrals but they were not significantly associated with any particular source of referral.
Referrals were received from a wide variety of sources with significant differences in age and duration of stroke of patients from different referral sources. The results suggest that an open referral system may make rehabilitation accessible to a broader range of patients with stroke living in the community.
通过使用开放式转诊系统，研究社区中风康复服务所评估患者的转诊模式及特征。
描述性研究。
英国伦敦南部一个健康区的两个行政区。
该服务在运营的前18个月内评估的276例中风患者。
患者转诊来源多样，包括医院（38%）、全科医生（18%）、社区护士（10%）、社会服务机构（9%）、自我转诊（8%）、社区物理治疗师（7%）以及家庭或护理人员（2%）。来自医院的转诊患者较为年轻（33%年龄在65岁以下），而来自社区卫生和社会服务机构的转诊患者年龄较大（44%年龄在75 - 84岁）（卡方检验：χ² = 23，自由度df = 9，p < 0.01）。自我转诊或由家庭或护理人员转诊的患者中，50%患有长期中风（>1年）；来自全科医生的患者中，46%患有急性中风（<4周）；37%的医院患者在中风后1至3个月就诊（卡方检验：χ² = 50.4，自由度df = 12，p < 0.001）。失禁患病率存在微小显著差异，肢体无力、视力障碍和言语障碍方面无显著差异。服务的前九个月和后九个月之间，转诊来源无显著变化。后九个月中，近期中风患者的比例显著增加（卡方检验：χ² = 22.8，自由度df = 5，p < 0.001）。在此期间，36%接受评估的患者在中风后四周内就诊，而前九个月这一比例为15%。中风患者中，8.7%被认为是不适当的转诊，但它们与任何特定转诊来源均无显著关联。
转诊来源广泛，不同转诊来源的患者在年龄和中风病程方面存在显著差异。结果表明，开放式转诊系统可能使更广泛的社区中风患者能够获得康复服务。
