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Tilvísanir til hjartalækna : viðhorf hjartasjúklinga og samskipti lækna

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Authors
Steinar Björnsson
Jóhann Ág. Sigurðsson
Alma Eir Svavarsdóttir
Gunnar Helgi Guðmundsson
Issue Date
2010-05-01

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Other Titles
Gatekeeping and referrals from GPs to cardiologists: patients' opinions and registration of information flow
Citation
Læknablaðið 2010, 96(5):335-40
Abstract
INTRODUCTION: Formal referrals to medical specialists have not been required in Iceland since 1984. In 2006, however, referrals were required for patients to receive reimbursement for cardiologists fees. We studied patients' experiences and opinions on the referral process and explored the potential for quality improvement related to the increase in written communication between referring GPs and cardiologists. MATERIAL AND METHODS: Based on the electronic medical record system, referrals from GPs at Efstaleiti Health Care Center in Reykjavík to cardiologists between 1 June 2006 and 1 April 2007 were analyzed. A total of 344 patients were referred in this period. 245 agreed to participate in a questionnaire study about their opinions on the referral system and 209 (85%) completed the questionnaire. Relevant data on previous contacts with the health care center and received consultants reports from the years 2005-7 were extracted from the record system. RESULTS: Participating patients had a mean age of 72 years, male/female ratio 1:1. Ninety percent (95% C.I. 86-94) regarded the new referral system as more expensive and troublesome, but 89% (95% C.I. 85-94) wanted their cardiologist to send a formal report to the referring GP. The number of reports from cardiologists to the health centre's GPs increased from 43 in 2005 to 326 in 2007. CONCLUSION: Implementation of a referral system led to some dissatisfaction among the patients. On the other hand, it led to a major increase in the information exchange between GPs and cardiologists, in clear accordance with patients' wishes. It would be of interest to study the impact of the increased information flow influenced on the health care delivered.
Inngangur: Árið 2006 varð greiðsluþátttaka sjúkratrygginga háð tilvísun heimilislækna til hjartalækna. Tilgangur þessarar rannsóknar var að kanna viðhorf sjúklinga til þessa tilvísanakerfis og hvort breytingin hafi leitt til aukinna samskipta í formi tilvísana og læknabréfa. Efniviður og aðferðir: Árið 2007 var gerð rannsókn á tilvísunum frá heimilislæknum Heilsugæslunnar Efstaleiti, Reykjavík, til sérfræðinga í hjartasjúkdómum. Skoðað var samskiptaform alls 344 einstaklinga sem fengu tilvísun til hjartalækna á tímabilinu 1. júní 2006 til 1. apríl 2007. Þar af samþykktu 245 að taka þátt í viðhorfskönnun um aðdraganda tilvísunar, viðhorf til þessa fyrirkomulags, kostnaðar og fyrirhafnar. Svör bárust frá 209 (85%). Úr sjúkraskrá stöðvarinnar voru jafnframt fengnar upplýsingar um fjölda samskipta hjartasjúklinga við heilsugæslustöðina og fjöldi læknabréfa á tímabilinu 2005 til 2007. Niðurstöður: Meðalaldur sjúklinga var 72 ár og kynjahlutfall jafnt. Níutíu prósent (95% öryggisbil 85,7-93,9) töldu að tilvísanir leiddu til meiri fyrirhafnar og eða auka kostnað. Áttatíu og níu prósent (95% öryggisbil 85,1- 93,5) töldu að hjartalæknir ætti að senda heimilislækni læknabréf. Heildarfjöldi læknabréfa frá hjartalæknum á stofu til heimilislæknanna jókst úr 43 árið 2005 í 326 yfir allt árið 2007. Ályktanir: Niðurstöður benda til þess að tilkoma tilvísanakerfis hafi vakið óánægju meðal sjúklinga. Tilvísanakerfi leiðir hins vegar til faglegs ávinnings með gagnkvæmri miðlun þekkingar fagaðila um sjúklinga sína sem er í samræmi við óskir þeirra sjálfra og líklegt til að auka gæði þjónustunnar.
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