Wagdi P, Bomio F, Tartini R
Herzzentrum Hirslanden, Zürich.
Dtsch Med Wochenschr. 1998 Nov 13;123(46):1367-71. doi: 10.1055/s-2007-1024189.
To compare the clinical characteristics of patients who referred themselves for specialist cardiological examination with those of patients referred by a general practitioner, to assess the usefulness of inserting a general practitioner or general physician before referral, and to project the likely cost effectiveness.
The data on 77 patients referred by a medical practitioner (group 1) were prospectively compared with those of a cohort of 65 patients who referred themselves for specialist cardiological examination (group 2). All patients fulfilling the inclusion criteria had been included consecutively over a period of one year. Excluded were patients with confirmed cardiological disease; those who had previously undergone specialist cardiological examination elsewhere; those who came for a second opinion; and those who had been referred as part of a medical insurance assessment or primarily for invasive tests. Comparisons were made regarding symptoms, investigations performed and the number of new cardiological diagnoses in each group. The assessments of the cardiologists regarding the presence or organic heart disease (before the performance of any diagnostic tests) was tested as to their sensitivity, specificity as well as their positive or negative predictive value.
Symptoms and incidence of organic heart disease differed significantly between the two groups. A doctor's referral to a cardiologist seemed to have a greater diagnostic and therapeutic advantage (filtre function). The cost of establishing a diagnosis of organic heart disease for group 1 patients was only about 80% of that for group 2 patients. A large proportion of group 2 patients did not wish the results to be transmitted to their general practitioner.
The relationship between patient and general practitioner needs improvement. Not included in this study were patients with organic heart disease who had not had any access to specialist cardiological investigation or only after a cardiac event.
比较自行前往专科心脏科检查的患者与由全科医生转诊的患者的临床特征，评估在转诊前安排全科医生进行诊治的效用，并预测其可能的成本效益。
对77例由医生转诊的患者（第1组）的数据与65例自行前往专科心脏科检查的患者队列（第2组）的数据进行前瞻性比较。所有符合纳入标准的患者在一年时间内连续纳入。排除已确诊心脏病的患者；之前在其他地方接受过专科心脏科检查的患者；寻求第二种意见的患者；以及作为医疗保险评估一部分转诊或主要为进行侵入性检查而转诊的患者。比较了两组患者的症状、所做检查以及新的心脏病诊断数量。对心脏病专家在任何诊断测试之前对器质性心脏病存在与否的评估进行了敏感性、特异性以及阳性或阴性预测值的测试。
两组患者的症状和器质性心脏病发病率存在显著差异。医生转诊至心脏病专家处似乎具有更大的诊断和治疗优势（筛选功能）。第1组患者确诊器质性心脏病的成本仅约为第2组患者的80%。第2组中有很大一部分患者不希望将结果告知其全科医生。
患者与全科医生之间的关系需要改善。本研究未纳入那些无法获得专科心脏科检查或仅在心脏事件后才获得检查的器质性心脏病患者。
