Assessment of referrals to a multidisciplinary outpatient clinic for patients with back pain.

Sasha Gulati, Asgeir S Jakola, Ole Solheim, Sindre Gabrielsen, Pål A Godø, Bjørn Skogstad, Oystein P Nygaard
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引用次数: 10

Abstract

Objective: Each year our multidisciplinary outpatient clinic for patients with back pain receives a large number of referrals from primary care physicians, manual physiotherapists, and chiropractors. We wanted to assess the quality of the referrals regarding the information provided about case history, clinical findings, and results from additional investigations.

Material and methods: Two hundred and eighty six consecutive referrals received in the time period from 1 October 2008 to 1 March 2009 were reviewed. We investigated if the referrals contained 12 given items. The items were defined by consensus of the broad range of specialists working at the multidisciplinary outpatient clinic. All registered items were regarded as useful when assigning patients with a priority and appropriate caregiver at the outpatient clinic. The 12 items that our group felt were reflective of good referrals were information about occupational status, duration of symptoms, pain distribution, sensory symptoms, use of analgesics, alleviating and/or aggravating factors, systems enquiry (i.e. urination, bowel movements, and sleep), provided treatment, deep tendon reflexes, motor function, sensory examination, and radiculopathy tests (i.e. straight leg raise and/or foraminal compression test).

Results: Two hundred and fifty six (89·5%) referrals were from primary care physicians, and the remaining came from physicians in internships, manual physiotherapists, and chiropractors. Six (2·1%) referrals contained all 12 items. On average each referral contained 5·95 items (95% CI: 5·66-6·25). Information about analgesics, sensory symptoms, systems enquiry, and alleviating and aggravating factors was most frequently missing. Information about provided treatment, motor function, deep tendon reflexes, clinical tests, and occupational status was included in about half of the referrals. In 27·3% of the referrals from primary care physicians information about clinical findings was missing. Referrals from manual physiotherapists contained statistically significant more information (9·67 items, 95% CI: 7·63-11·70) than from the other groups (P<0·001). The number of patients registered with each primary care physician did not affect the number of items in the referrals.

Conclusion: Many of the referrals were inadequate. Inadequate referrals can lead to prolonged waiting time for examination and treatment. Referrals with relevant information about patient history and clinical findings are essential in order to assign patients with an appropriate caregiver at the outpatient clinic and to determine if and which diagnostic imaging findings are of clinical relevance.

评估转介到一个多学科门诊诊所的病人背部疼痛。
目的:每年,我们的多学科门诊治疗背痛患者都会收到大量来自初级保健医生、手工物理治疗师和脊椎指压治疗师的转诊。我们希望评估转诊的质量,包括提供的病史、临床表现和其他调查结果的信息。材料和方法:对2008年10月1日至2009年3月1日期间收到的286份连续转诊进行了审查。我们调查了推荐是否包含12个给定项目。这些项目是由在多学科门诊工作的广泛专家的共识来定义的。所有登记的项目都被认为是有用的,当分配患者优先级和适当的护理人员在门诊诊所。我们小组认为反映良好转诊的12个项目包括:职业状况、症状持续时间、疼痛分布、感觉症状、镇痛药的使用、缓解和/或加重因素、系统询问(即排尿、排便和睡眠)、所提供的治疗、深肌腱反射、运动功能、感觉检查和神经根病检查(即直腿抬高和/或椎间孔压迫试验)。结果:256例(89.5%)转诊来自初级保健医生,其余来自实习医生、手工物理治疗师和脊医。6例(2.1%)转诊患者包含全部12项。平均每个转诊包含5.95个项目(95% CI: 5.66 - 6.25)。关于镇痛药、感觉症状、系统询问以及减轻和加重因素的信息最常缺失。提供的治疗、运动功能、深肌腱反射、临床检查和职业状况的信息包含在大约一半的转诊中。在27.3%的初级保健医生的转诊中,缺少有关临床表现的信息。手工物理治疗师的转诊信息(9.67项,95% CI: 7.63 ~ 11.70)高于其他组(p结论:许多转诊信息不充分)。转介不足会导致等待检查和治疗的时间延长。患者病史和临床表现的相关信息是必不可少的,以便在门诊为患者分配合适的护理人员,并确定哪些诊断成像结果与临床相关。
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