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首页> 外文期刊>Journal of Health Services Research & Policy >Improving the appropriateness of referrals and waiting times for endoscopic procedures
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Improving the appropriateness of referrals and waiting times for endoscopic procedures

机译：改善内窥镜检查的转诊和等待时间的适当性

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Objective: There is a lack of standard methods for determining the clinical priority of patients referred by general practitioners (GPs) for specialist outpatient consultations. We introduced a system of progressive involvement by general practitioners and specialists with 80 diagnostic procedures. The aim of this study was to evaluate this new method of prioritization of patients suffering from significant gastroenterological disorders needing rapid access to diagnostic procedures. nnMethods: The study included 438 outpatients who were referred for and underwent a gastroscopy or colonoscopy. GPs used a ranking of waiting times for different levels of clinical priority, called ‘homogeneous waiting groups’. Specialists also assigned a priority level for each patient as well as evaluating the appropriateness of the referral and the presence of significant endoscopic disorders. Agreement between GPs' and specialists' priority assessments was evaluated by the kappa statistic. nnResults: Most referrals (74.4%) were deemed low priority by GPs, with no maximum waiting time assigned. The level of agreement between GPs and specialists as regards patients' priorities was poor or moderate: for gastroscopy the kappa was 0.31 (weighted kappa 0.47) and for colonoscopy 0.44 (weighted kappa 0.46). There was an association between the proportion of significant disorders identified with endoscopy and the priority assigned to the referral (2 = 18.9, 1 df, p < 0.001). The overall proportion of referrals deemed inappropriate by specialists was 22.1%. nnConclusions: There is value in liaison between GPs and specialists for achieving timely referrals and avoiding delayed diagnosis though higher levels of agreement need to be achieved.
机译：目的：缺乏确定全科医师转诊至专科门诊的患者临床优先级的标准方法。我们引入了由全科医生和专家逐步介入的系统，并采用了80种诊断程序。这项研究的目的是评估这种对患有严重胃肠道疾病且需要快速进入诊断程序的患者进行优先排序的新方法。 nn方法：该研究包括438名接受了胃镜或结肠镜检查的门诊患者。全科医生使用了不同临床优先级的等待时间排名，称为“同类等待组”。专家还为每个患者分配了优先级，并评估了转诊的适当性以及是否存在明显的内镜疾病。全科医生和专家的优先评估之间的协议由kappa统计数据评估。 nn结果：GP认为大多数推荐（74.4％）的优先级较低，没有分配最大等待时间。全科医生和专家之间就患者优先事项达成的协议水平不佳或中等：对于胃镜检查，卡帕值为0.31（加权卡帕值为0.47），对于结肠镜检查为0.44（加权卡帕值为0.46）。内窥镜检查发现的重大疾病的比例与转诊的优先级之间存在关联（2 = 18.9，1 df，p <0.001）。专家认为不适当的转诊总比例为22.1％。 nn结论：尽管需要达成更高的协议水平，但全科医生和专家之间的联系很重要，可以实现及时转诊并避免延迟诊断。

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