Hsu J W, Chao M C, Tsai P L, Lu C C, Yu H S
Graduate Research Institute of Medicine, Kaohsiung Medical College, Taiwan, ROC.
J Adolesc Health. 1998 Aug;23(2):110-5. doi: 10.1016/s1054-139x(98)00011-1.
To determine the effect of the source of referral on appointment compliance of adolescents to referring doctors or to consultants at tertiary medical centers.
This analysis included 421 adolescent patients aged 10-18 years who were referred to the tertiary teaching hospital in Taiwan by 75 primary care doctors, including 56 pediatricians and 19 general practitioners in 1987-1996. Medical records were abstracted to determine clinical severity and demography. Data of compliance with return appointments were collected by an independently trained interviewer.
A total of 18.07% of referrals were initiated by patients or families and 81.93% were initiated by primary care doctors. More severe illness was found in patient-initiated referrals than in doctor-initiated referrals. After controlling for demographic, family features, medical payment, and doctor specialty, this study showed that if the referral were initiated by patients or families, adolescent patients were less likely to return to either the primary care doctors or tertiary teaching hospitals.
Although in a competitive environment, follow-up care is more likely to occur for both primary care doctors and consultants at tertiary teaching hospitals when the referral was initiated by primary care doctors.
确定转诊来源对青少年到转诊医生处或三级医疗中心的会诊医生处就诊依从性的影响。
本分析纳入了421例年龄在10至18岁之间的青少年患者，这些患者在1987年至1996年间由75名基层医疗医生转诊至台湾的三级教学医院，其中包括56名儿科医生和19名全科医生。提取病历以确定临床严重程度和人口统计学信息。由一名独立培训的访谈员收集复诊预约的依从性数据。
总共18.07%的转诊由患者或家属发起，81.93%由基层医疗医生发起。患者发起的转诊中发现的病情比医生发起的转诊更严重。在控制了人口统计学、家庭特征、医疗支付和医生专业后，本研究表明，如果转诊由患者或家属发起，青少年患者返回基层医疗医生处或三级教学医院的可能性较小。
尽管处于竞争环境中，但当转诊由基层医疗医生发起时，基层医疗医生和三级教学医院的会诊医生更有可能进行后续治疗。
