家庭醫學科轉診模式之研究

The Referral Pattern in the Family Medicine Clinic

10.6452/KJMS.198806.0350

許文燦(Wen-Chain Hsu)；劉宏文(Hong-Wen Liu)；黃洽鑽(Chia-Tsuan Huang)；馬遠成(Yuen-Sing Ma)；黃忠信(Chung-Shinn Hwang)；何鐵樑(Tit-Leung Ho)

family medicine ； referral pattern ； comprehensive care

The Kaohsiung Journal of Medical Sciences

4卷6期（1988 / 06 / 01）

350 - 357

繁體中文

109位肺結核病人接受抗結核藥物isoniazid治療後引起抗核抗體陽性之前瞻性研究。50位完成追蹤之病人中，有10位〈占20.0%〉抗核抗體轉陽性，但並沒有人發生紅斑性狼瘡症候群之臨床症候。籹性病人較男性病人容易發生抗核抗體陽性〈p＜0.01〉。這些陽性之抗核抗體血清經證實主要含抗組織酮〈histone〉之抗體。雖然這些病人亦接受其他抗結核藥物之治療，但文獻報告這些抗結核藥物中，只有isnoazid會引起抗核抗體。 本研究目的是針對家庭醫學科整體性照顧〈comprehensive care〉的分析，研究的對象是高雄醫學院家庭醫學科門診的所有就診病人，從民國七十二年十二月至七十六年十一月共四年期間，利用電腦建立起病人基本和診療資料，再加以追蹤處理。在此期間就診次數共有20,345人次，平均轉診率為3.24%。而四個年度平均轉診率分別為3.89%〈1984〉、3.75%〈1985〉、4.10%〈1986〉和2.49%〈1987〉。在疾病分佈上，以國際基層照顧健康問題分類法〈International Classification of Health Problems in Primary Care〉作為家庭醫學科轉出之診斷分類依據，其中以消化系統疾病最高，其次依序為徵象、症狀或未明狀況、生殖泌尿系統疾病、神經系統感決器官疾病。接受轉診顧問醫師之專科別中，以內科最多，其次依序為婦產科、眼科、外科、耳鼻喉科和泌尿科。由此可知加強家庭醫學科醫師與顧問醫師之溝通，和加強對高轉診疾病的診斷處理訓練是未來努力的目標。

For the study of comprehensive care limitations in the family medicine clinic of Kaohsiung Medical College Hospital between 1983 and 1987, the basic data and medical records were collected through computerassisted data base of the referrals. During the 48-month period, 660 referrals were carried out from 20,345 visits. The overall referral rate was 3.24%. The four annual referral rates were 3.89%(1984), 3.75%(3985), 4.10%(1986), and 2.49%(1987), respectively. The diagnoses made by the referring physician were categorized according to the International Classification of Health Problems in Primary Care, 2nd Edition (ICHPPC-2). Digestive system diseases were the most frequent problems for referral, followed by sign/symptom/ill-defined condition, genitourinary system diseases and nervous system/sense organ diseases. Internists were the most frequent referral consultants followed by obstetricians and gynecologists, ophthalmologists, surgeons, otolaryngologists and urological physicians. From this referral pattern, improving the communication between family physicians and consultants and strengthening the diagnosis and management training for diseases with high referral rate are essential for the future training program of family medicine.