Chait I, Glynne-Jones R, Thomas S
Wellhouse NHS Trust, Barnet, Herts.
Br J Gen Pract. 1998 May;48(430):1241-3.
The tradition of routine, long-term follow-up of cancer patients in the outpatient clinic has led to busy clinics and long waiting times. Many cancer patients are anxious and have become dependent on the specialist clinic for reassurance. General practitioners (GPs) have been shown to be willing to assume greater responsibility for the routine follow-up of breast cancer patients, but patients have demonstrated a preference for hospital follow-up. If patients are discharged unwillingly, their rehabilitation may be at the cost of an increased demand on GP practices.
To determine the consequences for GPs of discharging long-term cancer patients from a hospital outpatient follow-up clinic.
A consecutive sample of 65 patients under annual review in a hospital oncology clinic were offered a planned discharge in which their return to the clinic, if necessary, was guaranteed. The 41 patients who accepted discharge were monitored. Anxiety and depression rates were assessed using the Hospital Anxiety and Depression Scale (HADS) at the time of discharge and four months later at a home interview. The GPs of all patients who were discharged were sent questionnaires four and twelve months after discharge to evaluate consultation rates and change in psychological morbidity.
The results showed no significant increase in the consultation rates during the 12 months after discharge compared with the previous 12 months. There was no significant change in the level of patients' anxiety or depression at four months after discharge. The great majority of GPs (71%) reported no change in their perception of patients' levels of anxiety or depression. GPs thought there was a need for more specialist Macmillan nurses working in the community and highlighted the importance of fast-track specialist referral.
Discharging this group of long-term cancer survivors did not increase the workload of GPs. However, GPs' concern over the lack of availability of Macmillan nurses in the community suggests that primary care services may find it difficult to cope adequately with the special requirements involved in cancer patient care. Finally, there is a need to address the further training requirements of GPs in the routine follow-up of cancer patients.
在门诊对癌症患者进行常规长期随访的传统导致门诊繁忙，患者等待时间长。许多癌症患者焦虑不安，对专科门诊的安慰产生了依赖。全科医生（GP）已表明愿意承担更多乳腺癌患者常规随访的责任，但患者更倾向于在医院进行随访。如果患者不情愿出院，他们的康复可能会以增加对全科医生诊疗工作的需求为代价。
确定将长期癌症患者从医院门诊随访诊所出院对全科医生的影响。
在一家医院肿瘤门诊接受年度复查的65例患者连续样本被提供了有计划的出院安排，保证他们如有必要可返回诊所。对接受出院的41例患者进行了监测。在出院时以及四个月后进行家访时，使用医院焦虑抑郁量表（HADS）评估焦虑和抑郁率。所有出院患者的全科医生在出院后四个月和十二个月收到问卷，以评估诊疗率和心理发病率的变化。
结果显示，出院后12个月的诊疗率与前12个月相比没有显著增加。出院四个月后患者的焦虑或抑郁水平没有显著变化。绝大多数全科医生（71%）报告他们对患者焦虑或抑郁水平的看法没有改变。全科医生认为社区需要更多专科麦克米伦护士，并强调了快速专科转诊的重要性。
让这组长期癌症幸存者出院并没有增加全科医生的工作量。然而，全科医生对社区缺乏麦克米伦护士表示担忧，这表明初级保健服务可能难以充分应对癌症患者护理中涉及的特殊需求。最后，有必要解决全科医生在癌症患者常规随访方面的进一步培训需求。
