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An Analysis of Referral Initiative, Severity, and the Return of Older Population in a Tertiary Teaching Hospital

壹所第三線教學醫院之老年人轉診啟動、嚴重度及回診之研究

摘要


由於在臺灣老年人口比率的增加以及複雜的疾病,醫師對於年老者照顧更加關心。本研究之目的釐清轉診啟動及疾病嚴重度之關係並探討年老病人回到原轉診醫師及醫學中心之會診醫師之傾向如何。研究樣本包含65歲及以上病人397位在1987-1994間被診斷且由79位基層醫師轉診至第三線教學醫院之內科部門。轉診動機及回診傾向由醫師及訪問者分別收集。對所有老年病人,有22.93%之轉介是來自病人或家屬,有77.07%則是由基層醫師轉診而來。由醫師或病人轉診而來的疾病之MMSE(Mini-Mental State Examination),BADL(Basic Activities of Daily Living)或IADL(Instrumental Activities of Daily Living),並無統計上差異。醫師轉診與較高的GDS(Geriatric Depression Scale)有所相關。在年老者,疾病較嚴重者與由病人主導之轉診有相關。在控制了婚姻狀態、家庭型態、醫療保險、憂鬱狀態及嚴重度,本研究顯示若轉介是由病人或家屬所主導,年老病人較不可能回到原基層醫師或第三線教學醫院之會診醫師。若轉診由醫師主導則基層醫師或會診醫師之追蹤診療,較有可能發生。

關鍵字

嚴重度 轉診 回診 老年人 邏輯迴歸

並列摘要


Because of the increasing ratio of older people population in southern Taiwan and the more complicated illnesses of senior citizens, physicians in southern Taiwan are becoming more concerned about the care of older patients. The objective of this study was to determine the association between referral initiative and illness severity, as well as the tendencies of older patients to return to the referring doctor and to the consultant at a medical center. The sample included 397 patients, aged 65 and older who were diagnosed from 1987 to 1994 and patients who were referred to the Department of Internal Medicine of a tertiary teaching hospital by 79 primary care doctors. Referral initiative status and return tendency were collected from the doctor and the independent trained interviewer, respectively. Of all the older patient referrals, 22.93% of the referrals were initiated by patients or families, and 77.07% were initiated by primary care doctors. No statistical significance between doctor- and patient-initiated referrals was found in differences in Mini-Mental State Examination (MMSE), Basic Activities of Daily Living (BADL), or Instrumental Activities of Daily Living (IADL). The High Geriatric Depression Scale (GDS) was associated with doctor-initiated referrals. Severe illness was associated with patient-initiated referrals in the older population. After controlling for marriage, family type, medical payment, depression, and severity, this study showed that if the referral was initiated by patients of families, older patients were less likely to return to either the primary care doctors or consultants at a tertiary teaching hospital. Follow-up by doctors at primary care and consultants at a tertiary teaching hospital is more likely to occur if a doctor initiated the referral.

並列關鍵字

severity referral return rlderly logistic regression

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