检索结果-内蒙古大学图书馆

Patterns and appropriateness of referral from general dental practice to specialist oral and maxillofacial surgical services

引用

BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第4期38卷 320-325页

作者： Coulthard, P Koron, R Kazakou, I Macfarlane, TV Univ Manchester Dent Hosp Manchester M15 6FH Lancs England

In this study we investigated patterns of referral and appropriateness of referrals to specialist oral and maxillofacial surgery services, using postal questionnaires and referral letters. The most common reasons for referral were the expected difficulty of the operation, the medical condition of the patient and the lack of facilities for general anaesthesia, Most referrals were made to the oral and maxillofacial surgery department of a general hospital but almost three-quarters of the respondents stated that they would refer patients to specialist surgical dentistry practices in the future. Few referrals to a university department of oral and maxillofacial surgery were considered to be inappropriate, nor were requests for a particular type of anaesthesia. Any future transfer from secondary to primary care for oral surgery may be hindered by the reduction in facilities for general anaesthesia in the primary care setting.

关键词：麻醉牙科/统计学和数值数据临床工作能力牙医诊疗模式/统计学和数值数据英格兰开业医生牙科/统计学和数值数据卫生服务滥用/统计学和数值数据问卷调查转诊和会诊/统计学和数值数据外科口腔/统计学和数值数据成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Inappropriate use of an accident and emergency department:: Magnitude, associated factors, and reasons -: An approach with explicit criteria

引用

ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 568-579页

作者： Sempere-Selva, T Peiró, S Sendra-Pina, P Martínez-Espín, C López-Aguilera, I Fdn Inst Invest Serv Salud Valencia 46008 Spain Hosp Morales Meseguer Serv Urgencias Murcia Spain Hosp Gen Univ Serv Urgencias Elche Spain

Background: We evaluate the appropriateness of medical visits to the accident and emergency department (A&ED) of a university hospital using an instrument based on explicit and objective criteria, analyze the association between inappropriate visits and certain factors, and identify reasons for inappropriate use. Methods: This concurrent review of a random sample of 2,980 adult medical patients' visits to the A&ED of the hospital of Elche uses the Hospital Urgencies Appropriateness Protocol, an instrument based on explicit criteria. We analyze the association between inappropriate use and specific factors, and provide a descriptive analysis of reasons for inappropriate use assigned by A&ED staff. Results: Of the total number, 882 (29.6%) of the visits were evaluated as inappropriate. Inappropriate use was associated with younger patients, use of own means of transportation, referral by the hospital, certain months of the year, and certain diagnostic groups of lesser severity. The most frequent reasons for inappropriate use were the patients' greater trust in the hospital than primary care (451 [51.1%]), inappropriate use of services by patients (160 [18.1%]), and inappropriate referrals by primary care physicians (142 [16.1%]). Conclusion: Inappropriate use represents an important percentage of use of the A&ED. Many reasons contribute to it, although foremost among them is patient preference (and the convenience and accessibility) of these services compared with primary care.

关键词：年龄因素住院期间审核交叉研究诊断相关患者组/分类诊断相关患者组/统计学和数值数据急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究医院公立/利用医院大学/利用病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据初级卫生保健/利用问卷调查转诊和会诊/组织和管理居住特征/统计学和数值数据危险因素疾病严重程度指数西班牙/流行病学运输/统计学和数值数据成年人老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Appropriateness of emergency department visits in a Portuguese University Hospital

引用

ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 580-586页

作者： Pereira, S Silva, AOE Quintas, M Almeida, J Marujo, C Pizarro, M Angélico, V Fonseca, L Loureiro, E Barroso, S Machado, A Soares, M de Costa, AB de Freitas, AF Hosp Sao Joao Serv Med 2 P-4200 Porto Portugal

Study objective: There are no studies in Portugal supporting a common claim that most emergency department visits are inappropriate. The aim of this study was to determine the prevalence of and to evaluate factors associated with an appropriate ED visit in a major public hospital. Methods: A cross-sectional prospective study was performed at a public university hospital ED. Data for demographic variables, duration of complaint, transfer from other medical sources, and previous medical care for the same complaints were collected by interviewing all patients who arrived at the ED within a consecutive period of at least 24 hours. Data for diagnostic tests, treatment performed, and final patient destination were collected by triage records review. An appropriate ED visit was defined by explicit criteria: interhospital transfer, patient death at the ED, hospitalization, and diagnostic tests or treatments performed. Results: The study included 5,818 adult patients. The prevalence of an appropriate ED visit, by use of our criteria, was 68.7%. Sex was an effect modifier, According to this study, determinants of an appropriate visit for men and women were age 60 years or older and complaints of 24 hours or less and in women but not in men, retired from work and with arrival between midnight and 8 AM. Conclusions: In a university hospital in Oporto, the majority of ED visits were appropriate according to explicit criteria. Some variables may be associated with appropriateness of ED visits. A duration of the complaint 24 hours or less along with an arrival between midnight and 8 AM in women and age 60 years or older in men were the most important determinants.

关键词：年龄因素方差分析横断面研究教育程度急诊室医院/统计学和数值数据就业/统计学和数值数据卫生服务滥用/统计学和数值数据卫生服务研究医院公立/统计学和数值数据医院大学/统计学和数值数据 Logistic模型病人接受卫生保健的程度/心理学病人接受卫生保健的程度/统计学和数值数据葡萄牙/流行病学患病率前瞻性研究危险因素性别因素时间因素利用情况审核成年人老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Hysterectomy or an alternative?

引用

HOSPITAL PRACTICE 2000年第9期35卷 55-62页

作者： Shoupe, D Univ So Calif Sch Med Los Angeles CA 90089 USA

Even though hysterectomy remains an appealing solution for a number of nonmalignant gynecologic conditions, patients are often scheduled for surgery without proper evaluation or consideration of an alternative. For symptoms associated with uterine fibroids or endometriosis, there are alternative treatments that cause less morbidity, are less costly, and often are equally effective. Conservative management may also be appropriate for selected patients with early gynecologic cancer.

关键词：子宫内膜异位症/治疗卫生服务滥用/统计学和数值数据子宫切除术/经济学子宫切除术/统计学和数值数据子宫切除术/利用知情同意平滑肌瘤/治疗年患病率病人遴选骨盆痛/治疗卫生保健质量危险因素美国子宫肿瘤/治疗子宫脱垂/治疗女(雌)性人类

来源：评论

学校读者我要写书评

暂无评论

Appropriate standards for "Appropriateness" Research

引用

ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 629-632页

作者： Lowe, RA Abbuhl, SB Department of Biostatistics and Epidemiology Center for Clinical Epidemiology and Biostatistics University of Pennsylvania Medical Center Philadelphia PA United States Department of Emergency Medicine University of Pennsylvania Medical Center Philadelphia PA United States Univ. of Pennsylvania Med. Center Ctr. Clinic. Epidemiol./Biostatist. 914 Blockley Hall 423 Guardian Drive Philadelphia PA 19104-6021 United States

[Lowe RA, Abbuhl SB. Appropriate standards for “appropriateness” research. Ann Emerg Med. June 2001;37:629-632.]

关键词：急诊室医院/利用卫生服务滥用/统计学和数值数据卫生服务研究/标准葡萄牙出版/标准西班牙美国利用情况审核/标准人类

来源：评论

学校读者我要写书评

暂无评论

Frequent attenders to an emergency department: A study of primary health care use, medical profile, and psychosocial characteristics

引用

ANNALS OF EMERGENCY MEDICINE 2003年第3期41卷 309-318页

作者： Byrne, M Murphy, AW Plunkett, PK McGee, HM Murray, A Bury, G Natl Univ Ireland Univ Coll Galway Dept Gen Practice Galway Ireland St James Hosp Dept Emergency Med Dublin 8 Ireland Univ Dublin Trinity Coll Dublin 2 Ireland Royal Coll Surgeons Ireland Dept Psychol Hlth Serv Res Ctr Dublin 2 Ireland Univ Coll Dublin Dept Gen Practice Dublin 2 Ireland

Study objective: We describe, in comparison with a control group, frequent attenders to an emergency department in terms of their general health service use and their clinical, psychological, and social profiles. Methods: One hundred frequent attenders (those who had made A visits in the previous year) and 100 nonfrequent attenders matched for sex, age, and triage category were interviewed in the ED. Data were gathered on health service use, mental health (by using the General Health Questionnaire-12 item), and perceived social support (by using the Multidimensional Scale of Perceived Social Support). Patients' general practitioners were contacted to validate attendance data. Medical charts were searched for evidence of psychological problems and alcohol or drug abuse. Results: In the overall sample of 200 patients, 32% were female, and the mean age was 55 years (SO 20). Frequent attenders had made more visits to their general practitioner in the past year compared with control patients (median 12 versus 3 visits);a higher proportion of frequent attenders had used public health nursing services, community welfare services, social work services, addiction counseling, and psychiatric services in the past year. Frequent attenders had made more other hospital visits and had spent more nights in the hospital than control patients. General Health Questionnaire-12 item scores were higher for frequent attenders than control patients, indicating poorer mental health. Frequent attenders had lower levels of perceived social support. Conclusion: Frequent attenders to the ED are also heavy users of general practice services, other primary care services, and other hospital services. General Medical Services-eligible patients (84% of frequent attenders) frequently attend the ED, even though they have free access to primary care. Frequent attenders are a psychosocially vulnerable group, and service providers and policy makers need to take account of this vulnerable patient profile

关键词：病例对照研究横断面研究急诊室医院/利用卫生服务滥用/统计学和数值数据爱尔兰/流行病学精神障碍/流行病学病人接受卫生保健的程度/统计学和数值数据问卷调查社会支持成年人女(雌)性人类男(雄)性

来源：评论

学校读者我要写书评

暂无评论

Psychosocial and health belief variables associated with frequent attendance in primary care

引用

PSYCHOLOGICAL MEDICINE 1999年第6期29卷 1347-1357页

作者： Bellón, JA Delgado, A Luna, JD Lardelli, P Univ Granada Zaidin Sur Hlth Ctr Med Sch Family & Community Med Dept Prevent Med & Biostat E-18071 Granada Spain

Background. The reasons for high use of primary care, and in particular the role of psychosocial factors, remain unclear. Methods. We identified and interviewed 236 frequent attenders and 420 normal users, matched by age and sex, of a public Health Centre in Granada, Spain. Users were questioned about mental health (GHQ-28), social support (Duke-UNC-11), family dysfunction (family APGAR) and health beliefs (health belief model, locus of health control and medical care expectations). We also measured a set of individual, social and illness variables. Results. Multiple logistic regression analyses showed that mental health was the main factor associated with frequent attender status (odds ratio = 3.1;2.4-3.9). The association was stronger than that between frequent attender status and perceived illness, and between the former and reported chronic illness. Family dysfunction and perceived susceptibility to and severity of disease were also significantly but more weakly associated with frequent attender status. Affective support was more strongly associated with FA status than was confidant support, but both associations disappeared when mental health and family function were controlled for. Conclusions. Our findings document the association of psychosocial factors and primary health care use. We suggest that the effective management of mental health problems from a family-based approach may reduce primary health care high use.

关键词：慢性病/流行病学慢性病/心理学横断面研究家庭关系卫生服务滥用/统计学和数值数据体内外控制精神障碍/诊断精神障碍/心理学个性量表初级卫生保健/统计学和数值数据疾病角色社会支持西班牙青少年成年人老年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

Frequent attenders without organic disease in a gastroenterology clinic - Patient characteristics and health care use

引用

GENERAL HOSPITAL PSYCHIATRY 1999年第1期21卷 30-38页

作者： Bass, C Bond, A Gill, D Sharpe, M John Radcliffe Hosp Dept Psychol Med Oxford OX3 9DU England

We used a hospital computer to identify 50 patients (35 women, 15 men) satisfying research criteria for "frequent attenders" at a gastroenterology outpatient clinic (four or more visits to a general hospital clinic in the previous 12 months). Their mean duration of symptoms was 5 years, and 80% reported fatigue as a significant complaint. Thirteen (37%) of the women were also consulting a gynecologist, and in nine of these their status was normal. Seven (21%) of the 35 women who were interviewed had a history of childhood sexual abuse, and these patients reported significantly more lifetime somatic synptoms (9.7, SD = 3.8) than those without such a history (5.4, SD = 3.5, p = <0.01). The 50 patients reported high levels of disability and psychological distress, and were more likely to rate the probability of their symptoms as being due to "bowel disease" than to "stress" or "other problems." Forty-five patients had at least one current psychiatric diagnosis and 24 at least two, with somatoform disorders being the most common. Nineteen (38%) reported infrequent panic attacks, but only three Iran somatization disorder. The mean number of lifetime somatic symptoms was 5.9 (SD = 3.6 range 1-14). Seventeen patients (35%) also satisfied criteria for frequent attending in primary care (>12 visits over the previous 12 months), and the patients reported a mean number of 5.7 (SD = 2.1) specialist appointments in rite previous year. There may be a case for using the hospital computer to identify frequent attenders proactively at an earlier stage of their hospital visits so that appropriate management can be instituted. If such patients can be identified in this way, their assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff. (C) 1999 Elsevier Science Inc.

关键词：健康态度英格兰胃肠疾病/诊断胃肠疾病/心理学胃肠疾病/治疗卫生服务滥用/统计学和数值数据诊室就医/利用门诊部医院/利用门诊病人/分类门诊病人/心理学回顾性研究疾病角色躯体型障碍/诊断躯体型障碍/心理学应激心理学/诊断应激心理学/心理学成年人女(雌)性人类男(雄)性中年人

来源：评论

学校读者我要写书评

暂无评论

A framework for evaluating underutilization of health care services

引用

AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第2期14卷 89-97页

作者： Fetterolf, DE Highmark Inc Pittsburgh PA 15222 USA

Underutilization is becoming increasingly recognized as an area of importance in managed care, where aggressive measures to control overutilization are creating concern among the general public. The author sought solid definition of underutilization and methods for its evaluation in the medical literature but was impressed at the small number of peer reviewed articles on the subject. A review of key issues is discussed, including a number of methods a health plan may use to approach the identification of underutilization within its domain. Methods include the use of "gold standard" population health requirements;statistically defined underutilization;second-order, combined variables;and socially defined underutilization. Sample statistics identified within the author's plan are identified, and recommendations for their implementation and use are made.

关键词：坚持准则卫生服务易得程度卫生服务滥用/统计学和数值数据卫生服务研究/方法管理医疗规划/利用质量指标卫生保健转诊和会诊/统计学和数值数据美国利用情况审核/方法人类

来源：评论

学校读者我要写书评

暂无评论

Evaluating payment mechanisms: how can we measure unnecessary care?

引用

HEALTH POLICY AND PLANNING 1999年第4期14卷 409-413页

作者： Liu, XZ Mills, A Shandong Med Univ Sch Publ Hlth Jinan Peoples R China London Sch Hyg & Trop Med Dept Publ Hlth & Policy Hlth Econ & Financing Programme London England

There has been substantial concern that linking hospital or physician remuneration to the amount of care provided will encourage excessive provision of health care. Studies that seek to explore this relationship require methods to measure unnecessary care. This paper presents and discusses a method used to assess the magnitude of unnecessary care in the context of an evaluation of the impact of paying bonuses to physicians employed in public hospitals in Shandong Province, China.

关键词：中国横断面研究卫生经费支出卫生服务滥用/统计学和数值数据医院公立纵向研究组织状况研究医师奖励计划利用情况审核/方法青少年成年人老年人儿童儿童学龄前人类婴儿婴儿新生中年人

来源：评论

学校读者我要写书评

暂无评论

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案：

请选择收藏分类：

通借通还

建议与咨询 留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

时间限定

文献类型

馆藏选择

核心期刊

语言

文献类型

帮助

文字说明：

检索规则说明：

检索范例：

分类表

所选分类

限定检索结果

文献类型

馆藏范围

日期分布

学科分类号

主题

机构

作者

语言

请选择保存的检索档案： 新增检索档案 确定 取消

请选择收藏分类： 新增自定义分类 确定 取消

通借通还

建议与咨询留下您的常用邮箱和电话号码，以便我们向您反馈解决方案和替代方法

请选择保存的检索档案：

请选择收藏分类：