未分化疾病患者在综合医院全科与专科就诊情况对比研究
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摘要
背景未分化疾病(MUPS)患者的临床表现及实验室检查难以确诊为某个或某些疾病,影响疾病的最佳治疗时机,增加医疗花费;多数患者在基层医疗卫生机构经过初步诊治后,被转入医疗技术水平相对较高的综合医院,就诊于各个专科,而各个专科对MUPS患者的诊治有无差异,目前缺乏相关报道。目的比较MUPS患者在综合医院全科与专科的就诊情况,为MUPS患者在综合医院选择就诊科室提供依据。方法选择2017年在河北医科大学第二医院全科医疗科和专科住院的616例MUPS患者为研究对象,其中全科312例,专科304例。采用课题组成员设计的调查问卷对纳入对象进行调查,内容包括患者的基本情况、疾病确诊情况、周转科室数量、确诊所需时间及医疗花费、每日与主管医护人员交流时间、患者及家属对医护人员的满意度、随访情况。结果全科收治的MUPS患者的就诊原因涵盖了各专科,二者比较,差异无统计学意义(P>0.05);全科MUPS患者的疾病确诊率为75.6%(236/312),高于专科的60.5%(184/304),差异有统计学意义(P<0.05)。全科MUPS患者的周转科室数量少于专科,确诊所需时间短于专科,医疗花费低于专科,差异有统计学意义(P<0.05)。全科MUPS患者每日与主管医生及护士交流时间长于专科,患者及家属对医护人员的满意度高于专科,随访率高于专科,差异均有统计学意义(P<0.05)。结论大多数MUPS患者的健康问题在综合医院全科得到了更优化的解决,综合医院全科应承担起MUPS的诊治工作,为居民提供连续性的服务。
Background The clinical manifestations and auxiliary examinations on patients with medically unexplained physical symptoms(MUPS)are difficult to diagnose as one or some certain diseases,which may affect optimal treatment time and increase medical costs. Most patients are referred to general hospitals with relatively high medical technology after initial diagnosis and treatment in community medical and health institutions,consulting in various specialties. However,there is no relevant report on whether MUPS patients are treated differently in different specialties.Objective To analyze visit status of MUPS patients from general practice ward and specialist ward in general hospitals,so as to provide basis for MUPS inpatients to choose specialty departments in general hospitals.Methods A total of 616 patients who received treatment in general ward(312 cases)and specialist ward(304 cases)in the Second Hospital of Hebei Medical University in 2017 were selected as subjects.Patients were surveyed by self-developed questionnaire,including sociodemographic characteristics,diagnosis situation,number of referral,diagnosis time,treatment expenses,daily communication with doctors and nurses,patients' and family satisfaction and follow-up situation.Results Among the patients who were surveyed,their visit reasons of choosing general practice department covered different specialties,and there were no difference on the composition ratio of visit reasons(P>0.05).MUPS patients from general practice department gained higher overall level of diagnosis rate,of 75.6%(236/312),than those from specialist department,of 60.5%(184/304)(P<0.05).The number of referrals,diagnose time and treatment expenses in general practice department were significantly less than those in specialist departments(P<0.05).Daily communication time of patients with doctors and nurses in charge in general practice department were longer than that in specialist departments(P<0.05).Patients' and their family satisfaction and follow-up rate in general practice department were significantly higher than those in specialist departments(P<0.05).Conclusion Most patients with MUPS have gained more optimized treatments of their health problems in general practice department of general hospitals,therefore general practice department should undertake the diagnosis and treatment of patients with MUPS,to provide continuous services for residents.
Background The clinical manifestations and auxiliary examinations on patients with medically unexplained physical symptoms(MUPS)are difficult to diagnose as one or some certain diseases,which may affect optimal treatment time and increase medical costs. Most patients are referred to general hospitals with relatively high medical technology after initial diagnosis and treatment in community medical and health institutions,consulting in various specialties. However,there is no relevant report on whether MUPS patients are treated differently in different specialties.Objective To analyze visit status of MUPS patients from general practice ward and specialist ward in general hospitals,so as to provide basis for MUPS inpatients to choose specialty departments in general hospitals.Methods A total of 616 patients who received treatment in general ward(312 cases)and specialist ward(304 cases)in the Second Hospital of Hebei Medical University in 2017 were selected as subjects.Patients were surveyed by self-developed questionnaire,including sociodemographic characteristics,diagnosis situation,number of referral,diagnosis time,treatment expenses,daily communication with doctors and nurses,patients' and family satisfaction and follow-up situation.Results Among the patients who were surveyed,their visit reasons of choosing general practice department covered different specialties,and there were no difference on the composition ratio of visit reasons(P>0.05).MUPS patients from general practice department gained higher overall level of diagnosis rate,of 75.6%(236/312),than those from specialist department,of 60.5%(184/304)(P<0.05).The number of referrals,diagnose time and treatment expenses in general practice department were significantly less than those in specialist departments(P<0.05).Daily communication time of patients with doctors and nurses in charge in general practice department were longer than that in specialist departments(P<0.05).Patients' and their family satisfaction and follow-up rate in general practice department were significantly higher than those in specialist departments(P<0.05).Conclusion Most patients with MUPS have gained more optimized treatments of their health problems in general practice department of general hospitals,therefore general practice department should undertake the diagnosis and treatment of patients with MUPS,to provide continuous services for residents.
引文
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[7]王荣英,张金佳,赵稳稳,等.综合性三级甲等医院全科医学科在双向转诊中的作用研究[J].中国全科医学,2018,21(7):769-773.DOI:10.3969/j.issn.1007-9572.2018.07.004.WANG R Y,ZHANG J J,ZHAO W W,et al.Role analysis of general practice department of a general grade A tertiary hospital in bidirectional referrals[J].Chinese General Practice,2018,21(7):769-773.DOI:10.3969/j.issn.1007-9572.2018.07.004.
[8]刘娟娟,刘颖,任菁菁.常见未分化疾病的全科处理探讨[J].中国全科医学,2015,18(32):3985-3987.DOI:10.3969/j.issn.1007-9572.2015.32.021.LIU J J,LIU Y,REN J J.Study of the treatment of common undifferentiated diseases in general practice[J].Chinese General Practice,2015,18(32):3985-3987.DOI:10.3969/j.issn.1007-9572.2015.32.021.
[9]DUPUITS F M,HASMAN A,POP P.Computer-based assistance in family medicine[J].Comput Methods Programs Biomed,1998,55(1):39-50.
[10]孙俊杰,李双庆.综合性三级甲等医院全科门诊患者就诊体验及影响因素研究[J].中国全科医学,2018,21(7):774-777.DOI:10.3969/j.issn.1007-9572.2018.07.005.SUN J J,LI S Q.Experience and associated factors of consultation among primary care outpatients from the grade A tertiary general hospital[J].Chinese General Practice,2018,21(7):774-777.DOI:10.3969/j.issn.1007-9572.2018.07.005.
[11]OLDE HARTMAN T C,HASSINK-FRANKE L J,LUCASSEN P L,et al.Explanation and relations.How do general practitioners deal with patients with persistent medically unexplained symptoms:a focus group study[J].BMC Fam Pract,2009,10:68.DOI:10.1186/1471-2296-10-68.
[12]ROSENDAL M,CARLSEN A H,RASK M T.Symptoms as the main problem:a cross-sectional study of patient experience in primary care[J].BMC Fam Pract,2016,17:29.DOI:10.1186/s12875-016-0429-8.
[2]BUSVOLD K I H,BONDEVIK H.Medically unexplained physical symptoms,misunderstood and wrongly treated?A semiotic perspective on chronic pain[J].Physiother Theory Pract,2018,34(6):411-419.DOI:10.1080/09593985.2017.1422164.
[3]ROSENDAL M,OLDE HARTMAN T C,AAMLAND A,et al.'Medically unexplained'symptoms and symptom disorders in primary care:prognosis-based recognition and classification[J].BMC Fam Pract,2017,18(1):18.DOI:10.1186/s12875-017-0592-6.
[4]周仲华,黄文娟,陈仕银,等.三级综合医院全科医疗门诊患者就诊原因及诊断情况研究[J].中国全科医学,2012,15(23):2652-2655.DOI:10.3969/j.issn.1007-9572.2012.08.054.ZHOU Z H,HUANG W J,CHEN S Y,et al.Patient reasons for encounter and problems managed at a general practice clinic affiliated to a tertiary hospital[J].Chinese General Practice,2012,15(23):2652-2655.DOI:10.3969/j.issn.1007-9572.2012.08.054.
[5]王荣英,李峰,贺振银,等.河北省某三级综合医院全科医学科住院患者疾病谱分析[J].中华全科医师杂志,2016,15(11):845-849.DOI:10.3760/cma.j.issn.1671-7368.2016.11.007.WANG R Y,LI F,HE Z Y,et al.Disease profile of inpatients in general practice department of a grade A tertiary hospital[J].Chinese Journal of General Practitioners,2016,15(11):845-849.DOI:10.3760/cma.j.issn.1671-7368.2016.11.007.
[6]王荣英,李峰,支晓,等.基于门诊就诊疾病谱分析的综合医院全科医疗科在分级诊疗中的定位与发展探讨[J].中国全科医学,2016,19(28):3417-3421.DOI:10.3969/j.issn.1007-9572.2016.28.007.WANG R Y,LI F,ZHI X,et al.Orientation and development of general practice department of general hospital in hierarchical diagnosis and treatment based on disease spectrum of outpatients[J].Chinese General Practice,2016,19(28):3417-3421.DOI:10.3969/j.issn.1007-9572.2016.28.007.
[7]王荣英,张金佳,赵稳稳,等.综合性三级甲等医院全科医学科在双向转诊中的作用研究[J].中国全科医学,2018,21(7):769-773.DOI:10.3969/j.issn.1007-9572.2018.07.004.WANG R Y,ZHANG J J,ZHAO W W,et al.Role analysis of general practice department of a general grade A tertiary hospital in bidirectional referrals[J].Chinese General Practice,2018,21(7):769-773.DOI:10.3969/j.issn.1007-9572.2018.07.004.
[8]刘娟娟,刘颖,任菁菁.常见未分化疾病的全科处理探讨[J].中国全科医学,2015,18(32):3985-3987.DOI:10.3969/j.issn.1007-9572.2015.32.021.LIU J J,LIU Y,REN J J.Study of the treatment of common undifferentiated diseases in general practice[J].Chinese General Practice,2015,18(32):3985-3987.DOI:10.3969/j.issn.1007-9572.2015.32.021.
[9]DUPUITS F M,HASMAN A,POP P.Computer-based assistance in family medicine[J].Comput Methods Programs Biomed,1998,55(1):39-50.
[10]孙俊杰,李双庆.综合性三级甲等医院全科门诊患者就诊体验及影响因素研究[J].中国全科医学,2018,21(7):774-777.DOI:10.3969/j.issn.1007-9572.2018.07.005.SUN J J,LI S Q.Experience and associated factors of consultation among primary care outpatients from the grade A tertiary general hospital[J].Chinese General Practice,2018,21(7):774-777.DOI:10.3969/j.issn.1007-9572.2018.07.005.
[11]OLDE HARTMAN T C,HASSINK-FRANKE L J,LUCASSEN P L,et al.Explanation and relations.How do general practitioners deal with patients with persistent medically unexplained symptoms:a focus group study[J].BMC Fam Pract,2009,10:68.DOI:10.1186/1471-2296-10-68.
[12]ROSENDAL M,CARLSEN A H,RASK M T.Symptoms as the main problem:a cross-sectional study of patient experience in primary care[J].BMC Fam Pract,2016,17:29.DOI:10.1186/s12875-016-0429-8.