Chinese General Practice ›› 2023, Vol. 26 ›› Issue (31): 3945-3950.DOI: 10.12114/j.issn.1007-9572.2023.0059

• Article·Focus on Medically Unexplained Disease • Previous Articles     Next Articles

Visits for Medically Unspecified Disease in General Internal Medicine Clinics of County General Hospitals

  

  1. 1Department of General Practice, Affiliated Tiantai Hospital, Hangzhou Medical College, Taizhou 317200, China
    2Department of General Practice, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
  • Received:2023-02-07 Revised:2023-02-22 Published:2023-11-05 Online:2023-03-02
  • Contact: REN Jingjing

县级综合医院普通内科门诊未分化疾病就诊情况分析

  

  1. 1317200 浙江省台州市,杭州医学院附属天台医院全科医学科
    2310003 浙江省杭州市,浙江大学医学院附属第一医院全科医学科
  • 通讯作者: 任菁菁
  • 作者简介:
    作者贡献:娄铮、刘颖、任菁菁负责文章的构思与设计,以及文章语言润色、翻译修正、数据分析思路及论文的修订;娄铮负责调查实施、数据收集与整理、统计学处理、结果分析与解释及论文的撰写;任菁菁对文章整体负责,监督管理。
  • 基金资助:
    国家自然科学基金资助项目(72274169); 2021年浙江省教育厅一般科研项目(Y202146068); 2022年杭州医学院科技创新引导基金项目(CX2022021)

Abstract:

Background

Medically unspecified disease (MUD) is characterized by complex and diverse symptoms that cannot be clearly diagnosed or rationally explained, which often leads to frequent hospital attendance, imposing a heavy economic burden on individuals, families and the healthcare system.

Objective

To understand the visits for MUD in general internal medicine clinics in county general hospitals by analyzing the results of a survey, providing a theoretical basis for standardized treatment of MUD by integrating evidence from this epidemiological survey and our ideas for general diagnosis and treatment of MUD in county general hospitals.

Methods

From January to March 2021, conditional sampling was used to select all patients (n=45 439) who attended the general internal medicine clinic (85 881 visits in total) in a grade B tertiary county general hospital in Taizhou, Zhejiang Province from January 1 to December 31, 2020 through the hospital information system. Among whom, adult patients with MUD were screened using the PRESUME screening method, and information involving the demographics, time of consultation and reasons for consultation was collected for analysis.

Results

A total of 497 adult patients were identified with visits due to MUD, with a mean number of visits of 2.23 visits/person, and a mean age at visit of (51.6±15.9) years. There were sex-specific differences in age composition and attendances of MUD patients (P<0.01). As for the reasons for visits, men had more visits due to anxiety than women (P<0.05). The visits due to abdominal pain, anxiety and cough differed significantly by age (P<0.05). The visits in different seasons showed no significant differences by sex and age (P>0.05). The visits for cough differed significantly across the seasons (P<0.05) .

Conclusion

According to this survey, the visits due to MUD are influenced by various factors such as gender, age and season. Frequent visits for MUD due to various reasons cause difficulties in identifying and rationally treating the disease in the general internal medicine clinic as the first contact setting. To provide more accurate diagnosis and treatment for MUD patients, it is necessary to further develop the general medicine department, and make the general medicine department in county hospitals become the primary care center for MUD, and comprehensively enhance the effectiveness of county hospitals in serving the society.

Key words: Medically unspecified disease, Medical treatment, County hospitals, Internal medicine clinic, General practice

摘要:

背景

未分化疾病(MUD)以症状复杂、多样,无法得到明确诊断或合理解释,且患者频繁就诊为特点,给个人、家庭、医疗系统带来沉重的经济负担。

目的

通过了解县级综合医院普通内科门诊MUD就诊情况,进行就诊现状调查,提供流行病学数据,并提出县级综合医院MUD全科诊治思路,为MUD规范诊疗提供理论依据。

方法

于2021年1—3月,采用条件抽样法在医院管理信息系统(HIS)中抽取2020-01-01—2020-12-31于浙江省台州市某县三级乙等综合医院普通内科就诊的所有患者45 439例,合计就诊人次85 881次。采用PRESUME筛查方法筛选MUD成年患者,收集患者资料,进行人群特征、就诊时间分布、就诊原因特征分析。

结果

县级综合医院普通内科因MUD就诊的成年患者共497例,因MUD就诊的平均次数为2.23次/人,平均就诊年龄为(51.6±15.9)岁。不同性别普通内科门诊MUD患者就诊例数及就诊人次的年龄构成存在差异(P<0.01);不同性别MUD患者的就诊原因比较,男性因焦虑状态就诊的次数占比高于女性(P<0.05);不同年龄MUD患者的就诊原因比较,腹痛、焦虑状态、咳嗽就诊人次存在年龄分布差异(P<0.05)。不同季度的MUD就诊人次的性别、年龄比较,差异无统计学意义(P>0.05);不同季度就诊原因比较,咳嗽的就诊人次存在季度分布差异(P<0.05)。

结论

根据县级综合性医院普通内科门诊MUD就诊情况调查显示,MUD患者就诊情况受性别、年龄及季节等多种因素影响,患者就诊频繁、原因多样,普通内科门诊无法首诊识别MUD患者并给予合理的治疗,故而需要进一步发展全科医学科为MUD患者提供更准确的诊断和治疗,县级医院全科应成为MUD的基层诊疗中心,全面提升县级医院服务社会效能。

关键词: 未分化疾病, 就诊情况, 县级医院, 内科门诊, 全科医学