关键词: 骨质疏松, 社区卫生服务, 分级诊疗, 双向转诊, 专病门诊, 全科医生

Abstract: Background　Bi-directional referrals are essential in the promotion of community-based prevention and treatment of single diseases，but there is a lack of practical guidance scheme for clinical referrals. We aimed to explore the bi-directional referrals for osteoporosis between primary care and secondary or tertiary care involving primary care physicians，orthopedic specialists and other medical workers. Objective　To summarize the facilitators and barriers to successful bi-directional referrals for community osteoporosis patients based the reviewing of such studies，providing a reference for the improvement of bi-directional referrals for such patients. Methods　Databases of CNKI，Wanfang Data，Web of Science and Science Direct were searched in June 2019 for studies about bi-directional referrals for community osteoporosis patients included during January 1，1999 to June 15，2019. Meta-analysis was conducted on the practices and explorations of bi-directional referrals for community osteoporosis patients with a focus on the expected goal，types of referrals，development methods for new referral patterns，effects and problems during the implementation of referrals，and based on the results，improvement recommendations were proposed. Results　Finally, 14 Chinese documents and 5 English documents were included. The management modes and standards for transferring community osteoporosis patients were different in China and foreign countries during the period. Domestic residents did not attach much weight to osteoporosis，and showed poor adherence to treatment. Moreover，there were no osteoporosis department and sophisticated equipments for detecting osteoporosis as well as a sound system for communicating with higher level hospitals in domestic community hospitals. The types of referrals for such patients in foreign countries were mainly about the referrals for post-osteoporotic fracture patients. Conclusion　To promote community-based prevention and control of osteoporosis，bi-directional referrals for community osteoporosis patients should be implemented effectively，and to do this，priority should be given to：the determination of coverage of long-term preventive and control services of osteoporosis，enriching general practitioners' osteoporosis-related knowledge，improving the resources needed by community-based prevention and treatment of osteoporosis，and the development of a procedure for bi-directional referrals for osteoporosis including four factors such as division of labor，referral indicators and other details.

Key words: Osteoporosis, Community health services, Hierarchical diagnosis and treatment, Two-way referral, Specialized clinic, General practitioners