Our official English website, www.x-mol.net, welcomes your
feedback! (Note: you will need to create a separate account there.)
Referral decisions and its predictors related to orthopaedic care. A retrospective study in a novel primary care setting.
PLOS ONE ( IF 2.9 ) Pub Date : 2020-01-23 , DOI: 10.1371/journal.pone.0227863 Esther H A van den Bogaart 1 , Marieke D Spreeuwenberg 1, 2 , Mariëlle E A L Kroese 1 , Mark W van den Boogaart 3 , Tim A E J Boymans 3 , Dirk Ruwaard 1
PLOS ONE ( IF 2.9 ) Pub Date : 2020-01-23 , DOI: 10.1371/journal.pone.0227863 Esther H A van den Bogaart 1 , Marieke D Spreeuwenberg 1, 2 , Mariëlle E A L Kroese 1 , Mark W van den Boogaart 3 , Tim A E J Boymans 3 , Dirk Ruwaard 1
Affiliation
|
Due to the ageing population, the prevalence of musculoskeletal disorders will continue to rise, as well as healthcare expenditure. To overcome these increasing expenditures, integration of orthopaedic care should be stimulated. The Primary Care Plus (PC+) intervention aimed to achieve this by facilitating collaboration between primary care and the hospital, in which specialised medical care is shifted to a primary care setting. The present study aims to evaluate the referral decision following orthopaedic care in PC+ and in particular to evaluate the influence of diagnostic tests on this decision. Therefore, retrospective monitoring data of patients visiting PC+ for orthopaedic care was used. Data was divided into two periods; P1 and P2. During P2, specialists in PC+ were able to request additional diagnostic tests (such as ultrasounds and MRIs). A total of 2,438 patients visiting PC+ for orthopaedic care were included in the analysis. The primary outcome was the referral decision following PC+ (back to the general practitioner (GP) or referral to outpatient hospital care). Independent variables were consultation- and patient-related predictors. To describe variations in the referral decision, logistic regression modelling was used. Results show that during P2, significantly more patients were referred back to their GP. Moreover, the multivariable analysis show a significant effect of patient age on the referral decision (OR 0.86, 95% CI = 0.81-0.91) and a significant interaction was found between the treating specialist and the period (p = 0.015) and between patient's diagnosis and the period (p ≤ 0.001). Despite the significant impact of the possibility of requesting additional diagnostic tests in PC+, it is important to discuss the extent to which the availability of diagnostic tests fits within the vision of PC+. In addition, selecting appropriate profiles for specialists and patients for PC+ are necessary to further optimise the effectiveness and cost of care.
中文翻译：
与骨科护理相关的转诊决定及其预测因素。在新型初级保健环境中进行的回顾性研究。
由于人口老龄化，肌肉骨骼疾病的患病率以及医疗保健支出将继续上升。为了克服这些增加的支出，应该刺激骨科护理的整合。初级保健+（PC+）干预措施旨在通过促进初级保健和医院之间的合作来实现这一目标，其中专业医疗保健将转移到初级保健机构。本研究旨在评估 PC+ 中骨科护理后的转诊决定，特别是评估诊断测试对该决定的影响。因此，使用了到 PC+ 进行骨科护理的患者的回顾性监测数据。数据分为两个时期；P1 和 P2。在 P2 期间，PC+ 专家可以请求额外的诊断测试（例如超声波和 MRI）。分析中总共纳入了 2,438 名到 PC+ 接受骨科护理的患者。主要结局是 PC+ 后的转诊决定（返回全科医生 (GP) 或转诊至门诊医院护理）。自变量是咨询和患者相关的预测因素。为了描述转诊决策的变化，使用了逻辑回归模型。结果显示，在 P2 期间，被转回全科医生处的患者明显增多。此外，多变量分析显示患者年龄对转诊决策有显着影响（OR 0.86，95% CI = 0.81-0.91），并且发现治疗专家与时期（p = 0.015）以及患者诊断之间存在显着的交互作用和周期 (p ≤ 0.001)。尽管在 PC+ 中请求额外诊断测试的可能性产生了重大影响，但讨论诊断测试的可用性在多大程度上符合 PC+ 的愿景仍然很重要。此外，有必要为 PC+ 的专家和患者选择合适的资料，以进一步优化护理的有效性和成本。
更新日期：2020-01-24
中文翻译：
与骨科护理相关的转诊决定及其预测因素。在新型初级保健环境中进行的回顾性研究。
由于人口老龄化，肌肉骨骼疾病的患病率以及医疗保健支出将继续上升。为了克服这些增加的支出，应该刺激骨科护理的整合。初级保健+（PC+）干预措施旨在通过促进初级保健和医院之间的合作来实现这一目标，其中专业医疗保健将转移到初级保健机构。本研究旨在评估 PC+ 中骨科护理后的转诊决定，特别是评估诊断测试对该决定的影响。因此，使用了到 PC+ 进行骨科护理的患者的回顾性监测数据。数据分为两个时期；P1 和 P2。在 P2 期间，PC+ 专家可以请求额外的诊断测试（例如超声波和 MRI）。分析中总共纳入了 2,438 名到 PC+ 接受骨科护理的患者。主要结局是 PC+ 后的转诊决定（返回全科医生 (GP) 或转诊至门诊医院护理）。自变量是咨询和患者相关的预测因素。为了描述转诊决策的变化，使用了逻辑回归模型。结果显示，在 P2 期间，被转回全科医生处的患者明显增多。此外，多变量分析显示患者年龄对转诊决策有显着影响（OR 0.86，95% CI = 0.81-0.91），并且发现治疗专家与时期（p = 0.015）以及患者诊断之间存在显着的交互作用和周期 (p ≤ 0.001)。尽管在 PC+ 中请求额外诊断测试的可能性产生了重大影响，但讨论诊断测试的可用性在多大程度上符合 PC+ 的愿景仍然很重要。此外，有必要为 PC+ 的专家和患者选择合适的资料，以进一步优化护理的有效性和成本。
京公网安备 11010802027423号