英国初级卫生保健转诊系统对我国分级诊疗及基层医疗信息化建设的借鉴
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摘要
英国国家医疗服务体系包括初级卫生保健系统和医院系统,转诊推荐信是全科医生和专科医生间沟通的方式,其中包含的信息对于转诊质量和效率有提高的作用。研究转诊推荐信的信息有助于为我国的分级诊疗提供建议。本文通过检索有关组织机构制定的指南、规范,系统评价有关文献,得出主要关注指标,形成政策分析及建议。结果发现转诊推荐信的质量控制体系主要由英国国家卫生及医疗优化研究院制定的转诊指南、临床调试集团制定的关键绩效指标构成。英格兰地区在转诊选择、转诊期望、转诊时间、诊断等方面还有改善空间,但是患者对于现在的转诊基本满意。提示提高转诊质量需要做到规范转诊医疗行为,充分提升信息化在转诊中的作用,建立全科医生和专科医生之间的密切关系,引入非卫生技术人员作为全科医生助理等。
National Health Service(NHS)includes both primary health care system and hospital system.The referral letter is a means of communication between general practitioners and specialists,and the information contained therein has an impact on improving the quality and efficiency of the referral.Studying the information in the referral letter will help to provide advice for hierarchical medical service system in China.This paper systematically evaluated the relevant literatures by retrieving the guidelines and norms given by relevant organizations and drew the key indicators to form policy analysis and recommendations.The results showed that the indicators for quality control of the referral letter were mainly composed of the indicators in referral guidelines made by the National Institute for Health and Care Excellence(NICE)and the key performance indicators made by the NHS Clinical Commissioning Groups(CCG).In England while patients were generally satisfied with the current referral service,there was still room for improvement in terms of referral options,referral expectations,referral time,and diagnosis.These findings suggested that to improve the quality of referral required standardizing the referral medical behaviours,fully enhancing the role of medical informatization in the referral,establishing a close relationship between family doctors and specialists,and introducing non-public health technicians as family doctor assistants.
National Health Service(NHS)includes both primary health care system and hospital system.The referral letter is a means of communication between general practitioners and specialists,and the information contained therein has an impact on improving the quality and efficiency of the referral.Studying the information in the referral letter will help to provide advice for hierarchical medical service system in China.This paper systematically evaluated the relevant literatures by retrieving the guidelines and norms given by relevant organizations and drew the key indicators to form policy analysis and recommendations.The results showed that the indicators for quality control of the referral letter were mainly composed of the indicators in referral guidelines made by the National Institute for Health and Care Excellence(NICE)and the key performance indicators made by the NHS Clinical Commissioning Groups(CCG).In England while patients were generally satisfied with the current referral service,there was still room for improvement in terms of referral options,referral expectations,referral time,and diagnosis.These findings suggested that to improve the quality of referral required standardizing the referral medical behaviours,fully enhancing the role of medical informatization in the referral,establishing a close relationship between family doctors and specialists,and introducing non-public health technicians as family doctor assistants.
引文
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[8]NICEGuideline.Glaucoma:diagnosisandmanagement[EB/OL].[2018-12-20].https://www.nice.org.uk/guidance/ng81.
[9]Board Meetings[EB/OL].[2018-12-20].https://www.oxfordshireccg.nhs.uk/about-us/board-meetings.htm.
[10]MITCHELL E,MACDONALD S,CAMPBELL N C,et al.Influences on pre-hospital delay in the diagnosis of colorectal cancer:a systematic review[J].British Journal of Cancer,2008,98(1):60-70.DOI:10.1038/sj.bjc.6604096.
[11]BODEK S,GHORI K,EDELSTEIN M,et al.Contemporary referral of patients from community care to cardiology lack diagnostic andclinicaldetail[J].InternationalJournalofClinical Practice,2006,60(5):595-601.DOI:10.1111/j.1368-5031.2006.00902.x.
[12]ISINKAYE T,GILBERT S,SEDDON P,et al.How many paediatric referrals to an allergist could be managed by a general practitioner with special interest?[J].Pediatric Allergy andImmunology,2016,27(2):195-200.DOI:10.1111/pai.12506.
[13]RODERICK P,JONES C,TOMSON C,et al.Late referral for dialysis:improving the management of chronic renal disease[J].QJM,2002,95(6):363-370.
[14]KHATTAKI,EARDLEYNJ,ROONEYPS.Colorectal cancer:a prospective evaluation of symptom duration and GP referral patterns in an inner city teaching hospital[J].Colorectal Disease,2006,8(6):518-521.DOI:10.1111/j.1463-1318.2006.00967.x.
[15]LUCASSEN A,WATSON E,HARCOURT J,et al.Guidelines for referral to a regional genetics service:GPs respond by referring more appropriate cases[J].Family Practice,2001,18(2):135-140.
[2]NHS Digital.NHS payments to general practice,England,2016/17[EB/OL].(2017-09-20)[2018-12-20].https://digital.nhs.uk/data-and-information/publications/statistical/nhs-payments-to-general-practice/nhs-payments-to-generalpractice-england-2016-17.
[3]CATHERINE F.The quality of GP diagnosis and referral[EB/OL].[2018-12-20].https://www.kingsfund.org.uk/projects/gpinquiry/diagnosis-referral.
[4]LUCASSEN A,WATSON E,HARCOURT J,et al.Guidelines for referral to a regional genetics service:GPs respond by referring more appropriate cases[J].Family Practice,2001,18(2):135-140.
[5]EVANS E,AIKING H,EDWARDS A.Reducing variation in general practitioner referral rates through clinical engagement and peer review of referrals:a service improvement project[J].Quality in Primary Care,2011,19(4):263-272.
[6]NICE Guideline.Suspected cancer:recognition and referral[EB/OL].[2018-12-20].https://www.nice.org.uk/guidance/ng12.
[7]HSIANG J C,BAI W H,LAL D.Sa1167 symptom presentation and other characteristics of patients diagnosed with colorectal cancers and the relevance of the UK Nice Referral Guideline for suspected colorectal cancer in south Auckland population[J].Gastroenterology,2012,142(5-supp-s1):s233.DOI:10.1016/s0016-5085(12)60874-9.
[8]NICEGuideline.Glaucoma:diagnosisandmanagement[EB/OL].[2018-12-20].https://www.nice.org.uk/guidance/ng81.
[9]Board Meetings[EB/OL].[2018-12-20].https://www.oxfordshireccg.nhs.uk/about-us/board-meetings.htm.
[10]MITCHELL E,MACDONALD S,CAMPBELL N C,et al.Influences on pre-hospital delay in the diagnosis of colorectal cancer:a systematic review[J].British Journal of Cancer,2008,98(1):60-70.DOI:10.1038/sj.bjc.6604096.
[11]BODEK S,GHORI K,EDELSTEIN M,et al.Contemporary referral of patients from community care to cardiology lack diagnostic andclinicaldetail[J].InternationalJournalofClinical Practice,2006,60(5):595-601.DOI:10.1111/j.1368-5031.2006.00902.x.
[12]ISINKAYE T,GILBERT S,SEDDON P,et al.How many paediatric referrals to an allergist could be managed by a general practitioner with special interest?[J].Pediatric Allergy andImmunology,2016,27(2):195-200.DOI:10.1111/pai.12506.
[13]RODERICK P,JONES C,TOMSON C,et al.Late referral for dialysis:improving the management of chronic renal disease[J].QJM,2002,95(6):363-370.
[14]KHATTAKI,EARDLEYNJ,ROONEYPS.Colorectal cancer:a prospective evaluation of symptom duration and GP referral patterns in an inner city teaching hospital[J].Colorectal Disease,2006,8(6):518-521.DOI:10.1111/j.1463-1318.2006.00967.x.
[15]LUCASSEN A,WATSON E,HARCOURT J,et al.Guidelines for referral to a regional genetics service:GPs respond by referring more appropriate cases[J].Family Practice,2001,18(2):135-140.