Aaraas I, Fylkesnes K, Førde O H
Institute of Community Medicine, University of Tromsø, Norway.
Fam Pract. 1998 Jun;15(3):252-8. doi: 10.1093/fampra/15.3.252.
We aimed to explore the relative impact of medical and other situational motives on GP's decisions to refer patients to specialist care in a general hospital, and to assess whether having access to a GP hospital influences the decisions.
We carried out a prospective study of consecutive doctor-patient contacts during one week. The effects of main motives, medical, social/nursing, general hospital advice, distance from the nearest general hospital and access to GP hospitals on referral decisions were explored by logistic regression. The motives for different referral decisions were also explored through frequency analyses. The study was set in general practices in the county of Finnmark in North Norway, which included 40 GPs from rural practices with access to a GP hospital and eight GPs working closer to a general hospital without access to GP hospital. We studied 2496 doctor-patient contacts, which resulted in 411 patients being considered for any kind of referral, of which 205 were referred to the general hospital.
Medical needs were recorded as the only referral motive of major importance in about half of the cases considered for referral, while additional motives were recorded in the other half. The rationale for admissions to general hospitals and GP hospitals (in-patient care) was compatible in terms of the relative importance of the medical arguments. The GP hospital option was mainly chosen because of the long distance from the general hospital, nursing needs and the preferences of the patient and the family, and resulted in a lower proportion of patients being referred to general hospitals from GPs with access to a GP hospital.
Medical motives dominate the decision to refer patients to general hospitals, but access to a GP hospital, in cases where nursing needs and long distances to the general hospital are supplementary considerations, reduces the proportion of patients being referred to general hospitals.
我们旨在探讨医疗及其他情境因素对全科医生（GP）将患者转诊至综合医院专科护理决策的相对影响，并评估能否使用全科医生医院是否会影响这些决策。
我们对一周内连续的医患接触进行了一项前瞻性研究。通过逻辑回归分析探讨了主要动机（医疗、社会/护理、综合医院建议、与最近综合医院的距离以及能否使用全科医生医院）对转诊决策 的影响。还通过频率分析探讨了不同转诊决策的动机。该研究在挪威北部芬马克郡的全科诊所进行，其中包括来自农村诊所且能使用全科医生医院的40名全科医生，以及在离综合医院较近但无法使用全科医生医院的8名全科医生。我们研究了2496次医患接触，其中411名患者被考虑进行任何形式的转诊，其中205名被转诊至综合医院。
在约一半被考虑转诊的病例中，医疗需求被记录为唯一重要的转诊动机，而另一半病例记录了其他动机。就医疗理由 的相对重要性而言，综合医院和全科医生医院（住院护理）的收治理由是一致的。选择全科医生医院选项主要是因为距离综合医院较远、护理需求以及患者及其家属的偏好，这导致能使用全科医生医院的全科医生转诊至综合医院的患者比例较低。
医疗动机在将患者转诊至综合医院的决策中占主导地位，但在护理需求和距离综合医院较远是补充性考虑因素的情况下，能使用全科医生医院会降低转诊至综合医院的患者比例。
