论文部分内容阅读
背景因生活方式和手术干预而推荐患者进行转诊是全科医学临床肥胖管理的一部分。然而,目前的相关实践效果不佳。这一定性研究旨在描述影响全科医生为肥胖患者转诊的因素。方法对澳大利亚新南威尔士州4个地区的24名全科医生进行半结构定性访谈,访谈内容为针对肥胖患者的管理。应用归纳主题分析法进行定性分析。结果影响全科医生转诊决策的首要因素是态度、精力以及患者的积极性。生活方式干预转诊通常是经全科医生建议,受到患者和当地卫生系统的影响。转诊进行肥胖外科手术的要求通常由患者提出,受到医生以往有限经验、患者期待、支付能力和专业法律问题的影响。转诊与地区偏远程度或者手术转诊服务的可及性并无紧密联系。结论全科医生报告的因生活习惯和手术干预而进行转诊的行为存在不同。全科医生的转诊态度通常由以往有限的病例经验而形成,而不是通过更多的系统证据回顾,尤其是手术干预。可针对患者转诊结局,对全科医生进行培养和交流,从而改善这一状况。
Background The referral of patients for lifestyle and surgical intervention is part of clinical obesity management in general practice. However, the current relevant practice is ineffective. This qualitative study is designed to describe the factors that influence the referral of general practitioners to obese patients. METHODS: A semi-structured qualitative interview was conducted with 24 general practitioners in 4 districts of New South Wales, Australia. The interview was aimed at the management of obese patients. Application of inductive thematic analysis for qualitative analysis. Outcomes The primary factors influencing general practitioner referral were attitude, energy, and patient motivation. Lifestyles referrals are usually recommended by a general practitioner and influenced by the patient and the local health system. The referral requirements for obese surgery are usually presented by the patient, subject to the physician’s previous limited experience, patient expectation, ability to pay, and professional legal questions. Referral is not linked to the remoteness of the area or the accessibility of surgical referral services. Conclusions There is a difference in the referrals that general practitioners report due to lifestyle and surgical intervention. The referral attitude of GPs is usually based on the limited previous experience of the case, rather than through more systematic evidence reviews, especially surgical interventions. The situation may be ameliorated through patient referrals and general practitioner training and exchange.