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首页> 外文期刊>BMC Family Practice >Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania
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Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania

机译：立陶宛克莱佩达的四种主要医疗保健模式对专科医疗保健的推荐率差异

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Background Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician- to self-referral ratio. Conclusion Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those with a physician referral were more likely to have had higher co-morbidity.
机译：背景技术立陶宛的初级卫生保健（PHC）正在从苏联时期流行的体系中发生变化，该体系确保了免费获得专业卫生保健。当前，四种不同的PHC模型可以并行工作，这提供了研究其对推荐率的影响的机会。我们的目的是调查在调整合并症后，克莱佩达不同立陶宛PHC模型的转诊率是否存在差异。方法列出了在克莱佩达市和地区为居民提供服务的18种初级保健实践人口（250070居民）。四种PHC模式：农村国有家庭医疗实践，城市私营家庭医疗实践，国有综合诊所和私有综合诊所。从立陶宛国家疾病基金数据库中获得了克莱佩达的每次初级保健实践中2005年列出的患者和转诊信息。数据库记录包括有关年龄，性别，PHC模型，转诊和ICD 10诊断的信息。 Johns Hopkins ACG Case-Mix系统用于研究合并症。使用Poisson回归模型研究了来自不同PHC模型的推荐率。结果列有农村国有家庭药物治疗实践的患者比其他三种PHC模型的患者转诊至专门医疗机构的比率要低得多。合并症的增加与医师与自我推荐的比率更高相关。结论位于农村地区而不是城市地区的家庭医学做法对专科医疗的转诊率明显较低。目前尚无法确定这是由于组织，对医生的培训还是由于资金筹措，但表明在城市地区仍有改善初级卫生保健的空间。患者的居住地和合并症水平是转诊率的最重要因素。我们还发现，就合并症水平而言，看门人对转诊模式有影响，因此，经医生转诊的患者更有可能合并病。

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